UNITED STATES

SECURITIES AND EXCHANGE COMMISSION

Washington, D.C. 20549

 

FORM 10-Q

(Mark One)

 

 xQUARTERLY REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934

 

For the quarterly period endedSeptemberJune 30, 20172018

 

 ¨TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934

 

For the transition period from  ___ to ___.

Commission File No.

001-37392

 

Apollo Medical Holdings, Inc.

(Exact name of registrant as specified in its charter)

 

Delaware46-3837784

(State or other jurisdiction

of Incorporationincorporation or organization)

(IRS Employer Identification No.)

 

700 North Brand Boulevard, Suite 1400

Glendale, California 912031668 S. Garfield Avenue, 2nd Floor, Alhambra, CA 91801

(Address of principal executive offices)offices and zip code)

 

(818) 396-8050(626) 282-0288

(Issuer’sRegistrant’s telephone number) 

(Former name, former address and former fiscal year, if changed since last report)

Securities Registered Pursuant to Section 12(b) of the Act:

Title of each ClassName of each Exchange on which Registered
None

Securities Registered Pursuant to Section 12(g) of the Act:

Common Stock, $.001 Par Valuenumber, including area code) 

 

Indicate by check mark whether the registrant (1) has filed all reports required to be filed by Section 13 or 15(d) of the Securities Exchange Act of 1934 during the preceding 12 months (or for such shorter period that the registrant was required to file such reports), and (2) has been subject to such filing requirements for the past 90 days:  x  Yes    ¨   No

 

Indicate by check mark whether the registrant has submitted electronically and posted on its corporate Web site, if any, every Interactive Data File required to be submitted and posted pursuant to Rule 405 of Regulation S-T during the preceding 12 months (or for such shorter period that the registrant was required to submit and post such files).    x  Yes    ¨   No

 

Indicate by check mark whether the registrant is a large accelerated filer, an accelerated filer, a non-accelerated filer, a smaller reporting company or an emerging growth company. See the definitions of “large accelerated filer,” “accelerated filer”, “smaller reporting company” and “emerging growth company” in Rule 12b-2 of the Exchange Act. (Check one):

 

Large accelerated filer¨Accelerated filer¨
Non-accelerated filer¨(Do not check if a smaller reporting company)Smaller reporting companyx
 Emerging growth company ¨

 

If an emerging growth company, indicate by check mark if the registrant has elected not to use the extended transition period for complying with any new or revised financial accounting standards provided pursuant to Section 13(a) of the Exchange Act.¨

 

Indicate by check mark whether the registrant is a shell company (as defined in Rule 12b-2 of the Exchange Act): ¨YesxNo

 

As of November 08, 2017,August 6, 2018, there were 6,033,49533,522,327 shares of common stock $.001of the registrant, $0.001 par value per share, issued and outstanding.outstanding.

 

 

 

 

 

APOLLO MEDICAL HOLDINGS, INC.

 

INDEX TO FORM 10-Q FILING

 

TABLE OF CONTENTS

 

  PAGE
 PART IIntroductory Note3
Note About Forward-Looking Statements3
 
 PART I
FINANCIAL INFORMATION
 
   
Item 1.Condensed Consolidated Financial Statements – Unaudited5
 Balance Sheets as of SeptemberJune 30, 20172018 and MarchDecember 31, 20175
 Statements of OperationsIncome for the Three and Six Months ended SeptemberEnded June 30, 20172018 and 2016201767
 Statements of Cash Flows for the Six Months Ended SeptemberJune 30, 20172018 and 2016201778
 Notes to Condensed Consolidated Financial Statements - Unaudited810
Item 2.Management’s Discussion and Analysis of Financial Condition and Results of Operations2741
Item 3.Quantitative and Qualitative Disclosures about Market Risk3849
Item 4.Controls and Procedures.Procedures3849
   
 PART II

OTHER INFORMATION
 
   
Item 1.Legal Proceedings3950
Item 1A.Risk Factors3950
Item 2.Unregistered Sales of Equity Securities and Use of Proceeds4250
Item 3.Defaults uponUpon Senior Securities4251
Item 4.Mine Safety Disclosures4251
Item 5.Other Information4251
Item 6.Exhibits4251

 


2

INTRODUCTORY NOTE

 

Unless the context dictates otherwise, references in this Quarterly Report on Form 10-Q (the “Report”) to the “Company,” “we,” “us,” “our,” “ApolloMed” and similar words are to Apollo Medical Holdings, Inc., a Delaware corporation, and its consolidated subsidiaries and affiliated medical groups (includingentities, as appropriate, including its consolidated variable interest entities)entities (“VIEs”).

The Centers for Medicare& Medicaid Services (“CMS”) have not reviewed any statements contained in this Quarterly Report on Form 10-Q describing the participation of APA ACO, Inc. (“APAACO”) in the Next Generation ACO Model.next generation accountable care organization (“NGACO”) model.

 

Forward-Looking StatementsTrade names and trademarks of the Company and its subsidiaries referred to herein and their respective logos, are our property. This Quarterly Report on Form 10-Q may contain additional trade names and/or trademarks of other companies, which are the property of their respective owners. We do not intend our use or display of other companies’ trade names and/or trademarks, if any, to imply an endorsement or sponsorship of us by such companies, or any relationship with any of these companies.

NOTE ABOUT FORWARD-LOOKING STATEMENTS

 

This document contains “forward-looking statements” within the meaning of the Private Securities Litigation Reform Act of 1995, Section 27A of the Securities Act of 1933, as amended (the “Securities Act”), and Section 21E of the Securities Exchange Act of 1934, as amended (the “Exchange Act”). All statements other than statements of historical fact are “forward-looking statements” for purposes of federal and state securities laws, including, but not limited to, any statements about the proposed Merger (defined below), the benefits of the proposed Merger, our post-Mergerfuture business, financial condition, strategic transactions (including mergers, acquisitions and management services agreements), sources of revenue, operating results, plans, objectives, expectations and intentions, the expected timing of completion of the Merger, any projections of earnings, revenue or other financial items, such as our projected capitation from CMS;CMS and our future liquidity; any statements of theany plans, targets, strategies and objectives of management for future operations;operations such as any material opportunities that we believe exist for our company; any statements concerning anticipated proposed newor prospective services, developments, mergerstimelines, costs, investments, returns, effects or acquisitions,results such as our outlook regarding our NGACO, our integration-related costs following the closing of the reverse merger of Apollo Medical Holdings, Inc. and Network Medical Management, Inc., the expected substantial completion of such integration, and our strategic transactions, including the proposed Merger (defined below);prospects of and future investments for our strategic transactions; any statements regarding management'smanagement’s view of future expectations plans and prospects for us; any statements about prospective adoption of new accounting standards or effects of changes in accounting standards; any statements regarding future economic conditions or performance;performance of our company; any statements of belief; any statements of assumptions underlying any of the foregoing; and other statements that are not historical facts.

Forward-looking statements involve risks and uncertainties and are based on the current beliefs, expectations and certain assumptions of the Company’s management. Some or all of such beliefs, expectations and assumptions may not materialize or may vary significantly from actual results. We further caution that such statements are qualified by important economic, competitive, governmental and technological factors that could cause our business, strategy, or actual results or events to differ materially, or otherwise, from those in the forward-looking statements in this Report.

Forward-looking statements may be identified by the use of forward-looking terms such as “anticipate,” “could,” “can,” “may,” “might,” “potential,” “predict,” “should,” “estimate,” “expect,” “project,” “believe,” “think,” “plan,” “envision,” “intend,” “continue,” “target,” “seek,” “contemplate,” “budgeted,” “will,” “would,” and the negative of such terms, other variations on such terms or other similar or comparable words, phrases or terminology. These forward-lookingForward-looking statements present ourreflect current views with respect to future events and condition and are based on current estimates, expectations and assumptions only as of the date of this reportQuarterly Report on Form 10-Q and therefore are speculative in nature and subject to change. Except as required by law, we do not intend, and undertake no obligation, to update any forward-looking statement, whether as a result of the receipt of new information, the occurrence of future events, the change of circumstances or otherwise. We further do not accept any responsibility for any projections or reports published by analysts, investors or other third parties.

Although we believe that the expectations reflected in any of our forward-looking statements are reasonable, actual results could differ materially from those projected or assumed in any of our forward-looking statements. Our future financial condition and results of operations, as well as any forward-looking statements, are subject to change and significant risks and uncertainties that could cause actual condition, outcomes and results to differ materially from those indicated by such statements. Should one or more of these risks or uncertainties materialize, or should any expectations or assumptions underlying the relevant forward-looking statements including, without limitation,prove incorrect, it could significantly affect our operations and may cause the risk factors discussed in this Report, in our Annual Reportactual actions, results, financial condition, performance or achievements of the Company and its subsidiaries and variable interest entities to be substantially different from any future actions, results, financial condition, performance or achievements, expressed or implied by any such forward-looking statements, as being expected, anticipated, intended, planned, believed, sought, estimated or projected on Form 10-K for the year ended March 31, 2017 filed on June 29, 2017, and in the Registration Statement Amendment No. 2 on Form S-4/A filed by us and Network Medical Management, Inc. on November 9, 2017. basis of historical trends.

Some of the key factors impacting these risks and uncertainties include, but are not limited to:

 

·risks related to our ability, following the consummation of the reverse merger of Apollo Medical Holdings, Inc. and Network Medical Management, Inc., to raise capital as equitysuccessfully integrate operations of the two groups, including realizing the synergies anticipated from the transaction, which may not be fully realized or debtmay take longer to finance our ongoing operationsrealize than expected; and new acquisitions, for liquidity, or otherwise;

·our ability to retain key individuals,successfully locate new strategic targets and integrate our operations following mergers, acquisitions or other strategic transactions, including our Chief Executive Officer, Warren Hosseinion, M.D.,that the integration may be more costly or more time consuming and other members of senior management;

·the impact of rigorous competition in the healthcare industry generally;

·the uncertainty regarding the adequacy of our liquiditycomplex than anticipated and that synergies anticipated to pursue our business objectives;

·the fluctuations in the market value of our common stock;

·the impact on our business, if any, as a result of changes in the way market share is measured by third parties;be realized may not be fully realized or may take longer to realize than expected;

 

·our dependence on a few key payors;

   


·whether or notchanges in federal and state programs and policies regarding medical reimbursements and capitated payments for health services we receive an “all or nothing” annual payment from the CMS in connection with our participation in the Medicare Shared Savings Program (the “MSSP”);provide;

3

 

·the success of our focus on our next generation accountable care organization (“NGACO”),NGACO, to which we have devoted, and intend to continue to devote, considerable effort and resources, financial and otherwise, including whether we can manage medical costs for patients assigned to us within the capitation received from CMS and whether we can continue to participate in the All-Inclusive Population-Based Payment Mechanism (“AIPBP”AIPBP Mechanism”) Mechanism of the NGACO Model as payments thereunder represent a significant part of our total revenues;

 

·changesour expenses may exceed capitation payments, whether from CMS under the AIPBP Mechanism or health plans, which could lead to substantial losses, and uncertainty related to the final settlements of such incurred expenses and our actual earnings that are generally determined in federal and state programs and policies regarding medical reimbursements and capitated payments for health services we provide;subsequent periods;

·general economic uncertainty;

 

·the overall successimpact of our acquisition strategy in locatingemerging and acquiring new businesses, and the integration of any acquired businesses with our existing operations;competitors;

 

·any adverse development in general market, business, economic, labor, regulatory and political conditions;

·changing rules and regulations regarding reimbursements for medical services from private insurance, on which we are significantly dependent in generating revenue;

 

·any outbreak or escalation of acts of terrorism or natural disasters;

 

·changing government programs in which we participate for the provision of health services and on which we are also significantly dependent in generating revenue;

 

·industry-wide market factors,changes in laws and regulations and other market-wide developments affecting our industry in general and our operations in particular, including the impact of any change to applicable laws and regulations relating to trade, monetary and fiscal policies, taxes, price controls, regulatory approval of new products, licensingregistration and licensure, healthcare reform;

·general economic uncertainty;

·the impact of any potential future impairment of our assets;

·risks related to changesreform and reimbursements for medical services from private insurance, on which we are significantly dependent in accounting literature or accounting interpretations;

·generating revenue and the impact, including additional costs, of mandates and other obligations that may be imposed upon us as a result of new or revised federal and state healthcare laws, such as the Patient Protection and Affordable Care Act (the “ACA”), the rules and regulations promulgated thereunder, any executive or regulatory action with respect thereto and any changes with respect to any of the foregoing by legislative bodies (including the 115th United States Congress), including any possible repeal thereof;laws;

 

·risks related to our ability to consummate raise capital as equity or debt to finance our growth and strategic transactions;

·our ability to retain key individuals, including members of senior management;

·the pending merger (the “Merger”) with Network Medical Management, Inc. (“NMM”) and, ifimpact of rigorous competition in the proposed Merger is consummated, successfully integrate our operations with those of NMM; including (i) healthcare industry generally;

·the occurrenceimpact of any event, change or other circumstances that could give rise to potential future impairment of our assets;

·the terminationeffectiveness of the Merger Agreement or affect the timing or ability to complete the proposed Merger as contemplated, such as the inability to complete the proposed Merger due to the failure to obtain stockholder approval or the failure to satisfy other conditions to the closing of the proposed Merger or for any other reason or the occurrence of any legal or regulatory proceedings or other matters that affect the timing or ability to complete the Merger as contemplated; (ii) the effects of the proposed Merger on our current plans, operations, financial resultscompliance and business relationships, including any disruption from the Merger or the termination of the Merger Agreement on our current plans, operations and business relationships; (iii) diversion of management time on issuescontrol initiatives;

·risks related to the proposed Merger; (iv) the amount of costs, fees, expenses, impairments and charges related to the proposed Merger; (v) the risk that the businesses of NMM and the Company will not be integrated successfully,changes in accounting literature or that the integration will be more costly or more time consuming and complex than anticipated; (vi) the risk that synergies anticipated to be realized from the proposed Merger may not be fully realized or may take longer to realize than expected; and (vii) the uncertainty regarding the adequacy of the post-Merger combined company’s liquidity to pursue its business objectives;accounting interpretations; and

 

·general inefficiencies of trading on junior markets or quotations systems, including the need to comply on a state-by-state basis with state “blue sky” securities laws forfluctuations in the resalemarket value of our common stock currently quoted on OTC Pink, and the uncertainty related to our application for listing of our common stock on the NASDAQ Global Market effective as of the closing of the Merger as no assurance can be given that we can meet the listing requirements for the NASDAQ Global Market, including at the closing of the Merger, or that our application will ever be approved.securities.

 

For a detailed description of these and other factors that could cause our actual results to differ materially from those expressed in any forward-looking statement, please see the sectionItem 1A entitled “Risk Factors,” beginning on page 39 of this Quarterly Report on Form 10-Q, the section entitled “Risk Factors,” beginning on page 28 of our Annual Report on Form 10-K for the year ended MarchDecember 31, 2017 as filed with the U.S. Securities and Exchange Commission (the “SEC”(“SEC”) on June 29, 2017, and the section entitled “Risk Factors,” beginning on page 44 of the Registration Statement Amendment No.April 2, on Form S-4/A filed with the SEC by us and NMM on November 9, 2017.2018. In light of the foregoing, investors are advised to carefully read this Quarterly Report on Form 10-Q and our most recent Annual Report on Form 10-K in connection with the important disclaimers set forth above and are urged not to rely on any forward-looking statements in reaching any conclusions or making any investment decisions about us or our securities. Except as required by law, we do not intend, and undertake no obligation, to update any statement, whether as a result of the receipt of new information, the occurrence of future events, the change of circumstances or otherwise. We further do not accept any responsibility for any projections or reports published by analysts, investors or other third parties.


4

PART I FINANCIAL INFORMATION

 

ITEM 1. FINANCIAL STATEMENTS

 

APOLLO MEDICAL HOLDINGS, INC.

CONDENSED CONSOLIDATED BALANCE SHEETS

(UNAUDITED)

  June 30,
2018
  December 31,
2017
 
       
Assets        
         
Current assets        
Cash and cash equivalents $101,132,237  $99,749,199 
Restricted cash – short-term  8,040,870   18,005,661 
Fiduciary cash  1,294,503   2,017,437 
Investment in marketable securities  1,130,967   1,143,095 
Receivables, net  34,541,815   20,117,304 
Prepaid expenses and other current assets  6,622,549   3,126,866 
         
Total current assets  152,762,941   144,159,562 
         
Noncurrent assets        
Land, property and equipment, net  13,297,168   13,814,306 
Intangible assets, net  94,927,036   103,533,558 
Goodwill  189,604,746   189,847,202 
Loans receivable – related parties  7,500,000   5,000,000 
Loan receivable  10,000,000   10,000,000 
Investment in a privately held entity that does not report net asset value per share  405,000   - 
Investments in other entities – equity method  23,545,361   21,903,524 
Investment in joint venture – equity method  16,673,840   - 
Restricted cash – long-term  745,352   745,235 
Other assets  1,515,664   1,632,406 
         
Total noncurrent assets  358,214,167   346,476,231 
         
Total assets $510,977,108  $490,635,793 

5

APOLLO MEDICAL HOLDINGS, INC.

CONDENSED CONSOLIDATED BALANCE SHEETS (Continued)

(UNAUDITED)

 

  September 30,  March 31, 
  2017  2017 
       
ASSETS        
Cash and cash equivalents $30,203,773  $8,664,211 
Accounts receivable, net of allowance for doubtful accounts of $381,019 and $475,080, respectively  4,857,136   5,506,472 
Other receivables  372,334   464,085 
Due from affiliates  -   18,314 
Prepaid expenses and other current assets  298,477   269,168 
Total current assets  35,731,720   14,922,250 
         
Property and equipment, net  1,121,632   1,205,139 
Restricted cash  745,176   765,058 
Intangible assets, net  1,732,984   1,904,269 
Goodwill  1,622,483   1,622,483 
Other assets  219,174   225,358 
TOTAL ASSETS $41,173,169  $20,644,557 
         
LIABILITIES AND STOCKHOLDERS’ EQUITY        
Accounts payable and accrued liabilities $7,042,043  $7,883,373 
Medical liabilities  30,694,173   1,768,231 
Convertible note payable, net of debt issuance cost of $53,667 and $161,000, respectively  4,936,333   4,829,000 
Lines of credit  25,000   62,500 
Total current liabilities  42,697,549   14,543,104 
         
Note payable – related party  5,000,000   5,000,000 
Deferred rent liability  683,504   747,418 
Deferred tax liability  83,666   83,667 
TOTAL LIABILITIES  48,464,719   20,374,189 
         
COMMITMENTS AND CONTINGENCIES (see Note 8)        
         
STOCKHOLDERS’ (DEFICIT) EQUITY        
Series A Preferred stock, par value $0.001; 5,000,000 shares authorized (inclusive of Series B Preferred stock); 1,111,111 issued and outstanding Liquidation preference of $9,999,999  7,077,778   7,077,778 
Series B Preferred stock, par value $0.001; 5,000,000 shares authorized (inclusive of Series A Preferred stock) 555,555 issued and outstanding Liquidation preference of $4,999,995  3,884,745   3,884,745 
Common stock, par value $0.001; 100,000,000 shares authorized; 6,052,518 and 6,033,518 shares issued and outstanding, respectively  6,053   6,033 
Additional paid-in capital  26,836,238   26,331,948 
Accumulated deficit  (45,148,985)  (37,654,381)
Stockholders’ deficit attributable to Apollo Medical Holdings, Inc.  (7,344,171)  (353,877)
Non-controlling interest  52,621   624,245 
Total stockholders’ (deficit) equity  (7,291,550)  270,368 
TOTAL LIABILITIES AND STOCKHOLDERS’ (DEFICIT) EQUITY $41,173,169  $20,644,557 
  June 30,
2018
  December 31,
2017
 
       
Liabilities, Mezzanine Equity and Stockholders’ Equity        
         
Current liabilities        
Lines of credit, short-term $-  $5,025,000 
Accounts payable and accrued expenses  12,587,893   13,279,620 
Incentives payable  5,104,074   21,500,000 
Fiduciary accounts payable  1,294,503   2,017,437 
Medical liabilities  66,853,335   63,972,318 
Income taxes payable  2,900,056   3,198,495 
Bank loan, short-term  278,017   510,391 
Capital lease obligations  100,228   98,738 
         
Total current liabilities  89,118,106   109,601,999 
         
Noncurrent liabilities        
Lines of credit, long-term  13,000,000   - 
Deferred tax liability  27,758,780   24,916,598 
Liability for unissued equity shares  1,185,025   1,185,025 
Dividends payable  8,617,210   18,000,000 
Capital lease obligations, net of current portion  568,512   619,001 
         
Total noncurrent liabilities  51,129,527   44,720,624 
         
Total liabilities  140,247,633   154,322,623 
         
Commitments and Contingencies (Note 11)        
         
Mezzanine equity        
Noncontrolling interest in Allied Pacific of California IPA (“APC”)  195,914,319   172,129,744 
         
Stockholders’ equity        
Series A Preferred stock, par value $0.001; 5,000,000 shares authorized (inclusive of Series B Preferred stock); 1,111,111 issued and zero outstanding  -   - 
Series B Preferred stock, par value $0.001; 5,000,000 shares authorized (inclusive of Series A Preferred stock); 555,555 issued and zero outstanding  -   - 
Common stock, par value $0.001; 100,000,000 shares authorized, 32,841,170 and 32,304,876 shares outstanding, excluding 1,682,110 treasury shares held by APC, at June 30, 2018 and December 31, 2017, respectively (see Note 10)  32,841   32,305 
Additional paid-in capital  162,027,547   158,181,192 
Retained earnings  7,561,556   1,734,531 
   169,621,944   159,948,028 
         
Noncontrolling interest  5,193,212   4,235,398 
         
Total stockholders’ equity  174,815,156   164,183,426 
         
Total liabilities, mezzanine equity and stockholders’ equity $510,977,108  $490,635,793 

 

The accompanying notes are an integral part of these unaudited condensed consolidated financial statements.

 

6

 

 

APOLLO MEDICAL HOLDINGS, INC.

CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONSINCOME

(UNAUDITED)

 

  Three Months Ended
September 30,
  Six Months Ended
September 30,
 
  2017  2016  2017  2016 
             
Net revenues $40,483,346  $14,622,656  $82,058,826  $26,994,329 
                 
Costs and expenses                
Cost of services  39,096,618   12,171,183   79,336,260   22,304,188 
General and administrative  5,345,742   4,455,329   10,234,926   8,291,804 
Depreciation and amortization  155,937   170,555   311,204   335,213 
                 
Total costs and expenses  44,598,297   16,797,067   89,882,390   30,931,205 
                 
Loss from operations  (4,114,951)  (2,174,411)  (7,823,564)  (3,936,876)
                 
Other (expense) income                
Interest expense  (199,662)  (3,054)  (392,651)  (5,713)
Gain (loss) on change in fair value of warrant liabilities  -   511,111   -   1,333,333 
Other income (expense)  54,635   10,560   93,295   12,531 
                 
Total other income (expense), net  (145,027)  518,617   (299,356)  1,340,151 
                 
Loss before benefit from income taxes  (4,259,978)  (1,655,794)  (8,122,920)  (2,596,725)
                 
Benefit from income taxes  (26,858)  (185,040)  (56,692)  (226,593)
                 
Net loss $(4,233,120) $(1,470,754) $(8,066,228) $(2,370,132)
                 
Net (income) loss attributable to non-controlling interest  350,382   112,345   571,624   (303,534)
                 
Net loss attributable to Apollo Medical Holdings, Inc. $(3,882,738) $(1,358,409) $(7,494,604) $(2,673,666)
                 
Net loss per share:                
Basic and diluted $(0.64) $(0.23) $(1.24) $(0.45)
                 
Weighted average number of shares of common stock outstanding:                
Basic and diluted  6,035,159   6,024,605   6,034,343   5,970,015 
                 
  Three Months Ended
June 30,
  Six Months Ended
June 30,
 
  2018  2017  2018  2017 
Revenue                
Capitation, net $90,316,182  $62,879,587  $176,221,466  $127,595,720 
Risk pool settlements and incentives  13,866,217   8,358,598   31,852,953   19,495,798 
Management fee income  12,371,608   6,287,702   24,446,180   12,824,812 
Fee-for-service, net  5,679,469   3,044,548   13,427,578   5,708,461 
Other income  771,070   741,265   1,223,096   1,022,971 
                 
Total revenue  123,004,546   81,311,700   247,171,273   166,647,762 
                 
Expenses                
Cost of services  99,464,892   66,672,236   184,135,500   126,214,808 
General and administrative expenses  11,471,829   5,777,187   23,207,727   11,053,762 
Depreciation and amortization  4,918,078   4,805,979   9,976,590   9,642,330 
                 
Total expenses  115,854,799   77,255,402   217,319,817   146,910,900 
                 
Income from operations  7,149,747   4,056,298   29,851,456   19,736,862 
                 
Other income (expense)                
Income (loss) from equity method investments  1,669,861   (795,102)  1,641,837   1,432,160 
Interest expense  (110,683)  (575)  (195,684)  (1,386)
Interest income  339,816   209,492   609,634   391,777 
Change in fair value of derivative instruments  -   (1,394,443)  -   127,779 
Other income  340,659   26,624   428,652   28,138 
                 
Total other income (expense), net  2,239,653   (1,954,004)  2,484,439   1,978,468 
                 
Income before provision for income taxes  9,389,400   2,102,294   32,335,895   21,715,330 
                 
Provision for income taxes  1,523,807   736,835   8,752,647   8,626,080 
                 
 Net income  7,865,593   1,365,459   23,583,248   13,089,250 
                 
Net income (loss) attributable to noncontrolling interest  5,201,491   (629,284)  18,758,691   6,744,846 
                 
Net income attributable to Apollo Medical Holdings, Inc. $2,664,102  $1,994,743  $4,824,557  $6,344,404 
                 
Earnings per share – basic $0.08  $0.08  $0.15  $0.25 
                 
Earnings per share – diluted $0.07  $0.07  $0.13  $0.22 
                 
Weighted average shares of common stock outstanding-basic  32,674,459   25,067,954   32,548,662   25,067,954 
                 
Weighted average shares of common stock outstanding – diluted  

37,850,679

   28,417,877   37,935,773   28,417,877 

 

The accompanying notes are an integral part of these unaudited condensed consolidated financial statements.


7

APOLLO MEDICAL HOLDINGS, INC.

CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS

(UNAUDITED)

  Six Months Ended 
  June 30, 
  2018  2017 
       
Cash flows from operating activities        
Net income $23,583,248  $13,089,250 
Adjustments to reconcile net income to net cash provided by operating activities:        
Depreciation and amortization  9,976,590   9,642,330 
Loss on disposal of property and equipment  41,782   - 
Share-based compensation  1,036,326   642,466 
Unrealized loss from investment in equity securities  16,060   - 
Change in fair value of derivative instrument  -   (127,779)
Income from equity method investments  (1,641,837)  (1,432,160)
Deferred tax  706,813   (4,419,701)
Changes in operating assets and liabilities:        
Receivables, net  (2,824,511)  14,775,701 
Prepaid expenses and other current assets  (3,495,683)  (975,914)
Other assets  (95,258)  (86,452)
Accounts payable and accrued expenses  (692,000)  (1,808,721)
Dividends payable  617,210   - 
Incentives payable  (16,395,926)  (8,021,645)
Medical liabilities  2,881,017   (437,795)
Income taxes payable  (298,439)  3,861,749 
Net cash provided by operating activities  13,415,392   24,701,329 
         
Cash flows from investing activities        
Purchases of marketable securities  (3,932)  (1,301)
Repayments from related parties – loans receivable  -   200,000 
Advances to related parties – loans receivable  (2,500,000)  (5,000,000)
Purchase of investments – joint venture  (16,673,840)  - 
Dividends received from equity method investments  -   1,000,000 
Purchase of investment in a privately held entity  (405,000)  - 
Proceeds on sale of investments – cost method  -   25,000 
Purchases of property and equipment  (682,712)  (943,395)
Net cash used in investing activities  (20,265,484)  (4,719,696)
         
Cash flows from financing activities        
Repayment of bank loan  (257,374)  - 
Dividends paid  (12,000,000)  (9,490,632)
Change in noncontrolling interest capital  27,500   - 
Borrowings on line of credit  8,000,000   - 
Payment of capital lease obligations  (48,999)  (54,555)
Proceeds from sale of common stock of VIE  200,000   - 
Proceeds from the exercise of stock options and warrants  2,347,329   425,025 
Net cash used in financing activities  (1,731,544)  (9,120,162)
         
Net (decrease) increase in cash, cash equivalents and restricted cash  (8,581,636)  10,861,471 
         
Cash, cash equivalents and restricted cash, beginning of period  118,500,095   54,925,712 
         
Cash, cash equivalents and restricted cash, end of period $109,918,459  $65,787,183 
         
Supplementary disclosures of cash flow information:        
Cash paid for income taxes $11,612,590  $9,195,024 
Cash paid for interest  144,544   1,386 

8

APOLLO MEDICAL HOLDINGS, INC.

CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS

(UNAUDITED)

 

  Six Months Ended 
  September 30, 
  2017  2016 
       
CASH FLOWS FROM OPERATING ACTIVITIES:        
Net loss $(8,066,228) $(2,370,132)
Adjustments to reconcile net loss to net cash provided by (used in) operating activities:        
Provision for doubtful accounts, net of recoveries  90,037   69,633 
Loss on disposal of property and equipment  -   6,185 
Depreciation and amortization expense  311,204   335,213 
Stock-based compensation expense  418,810   493,758 
Amortization of deferred financing costs  107,333   37,926 
Gain on change in fair value of warrant liabilities  -   (1,333,333)
Changes in assets and liabilities:        
     Restricted cash  19,882   - 
Accounts receivable  559,299   (1,254,806)
Other receivables  91,750   290,272 
Due from affiliates  18,314   453 
Prepaid expenses and other current assets  (29,309)  (136,450)
Other assets  6,184   (5,537 
Accounts payable and accrued liabilities  (841,330)  (27,596)
Deferred rent liability  (63,914)  90,498 
Medical liabilities  28,925,942   (601,317)
Net cash provided by (used in) operating activities  21,547,974   (4,405,233)
         
Cash flows from investing activities:        
Property and equipment acquired  (56,412)  (205,775)
Net cash used in investing activities  (56,412)  (205,775)
         
Cash flows from financing activities:        
Proceeds from lines of credit  -   75,000 
Principal payments on lines of credit  (37,500)  (62,500)
Distributions to non-controlling interest shareholder  -   (1,050,000)
Proceeds from the exercise of warrants/options  85,500   172,000 
Net cash provided by (used in) financing activities  48,000   (865,500)
         
 Net change in cash and cash equivalents  21,539,562   (5,476,508)
Cash and cash equivalents, beginning of period  8,664,211   9,270,010 
         
Cash and cash equivalents, end of period $30,203,773  $3,793,502 
         
Supplementary disclosures of cash flow information:        
         
Interest paid $872  $10,199 
Income taxes paid $17,700  $16,400 
Supplemental disclosures of non-cash investing and financing activities        
Cashless exercise of stock options $47  $- 
Deferred tax liability adjustment to goodwill  1,110,456   - 
Cumulative effect adjustment for ASC 606 included in accounts receivable  11,600,000   - 
Cumulative effect adjustment for ASC 606 included in deferred tax liabilities  3,246,098   - 
Purchase price adjustment for acceleration of vested stock options  868,000   - 
Reclassification of stock options exercised to liability for unissued common shares  -   425,025 
Reclassification of fiduciary cash to payable $722,934  $2,911 

The following table provides a reconciliation of cash, cash equivalents, and restricted cash reported within the condensed consolidated balance sheets that sum to the total amounts of cash, cash equivalents, and restricted cash shown in the condensed consolidated statements of cash flows.

  

Six Months Ended

June 30,

 
  2018  2017 
Cash and cash equivalents $101,132,237  $65,787,183 
Restricted cash – long-term - letters of credit  745,352   - 
Restricted cash – short-term - distributions to former NMM shareholders  8,040,870   - 
Total cash, cash equivalents, and restricted cash shown in the statement of cash flows $109,918,459  $65,787,183 

 

The accompanying notes are an integral part of these unaudited condensed consolidated financial statements. 


9

APOLLO MEDICAL HOLDINGS, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS

(UNAUDITED)

 

1.Description of Business

 

Overview

 

Apollo Medical Holdings, Inc. (“ApolloMed”), entered into an Agreement and Plan of Merger dated as of December 21, 2016 (as amended on March 30, 2017 and October 17, 2017) (the “Merger Agreement”) among ApolloMed, Apollo Acquisition Corp., a California corporation and wholly-owned subsidiary of ApolloMed, Network Medical Management, Inc. (“NMM”), and Kenneth Sim, M.D., not individually but in his capacity as the Company” or “ApolloMed”representative of the shareholders of NMM, pursuant to which ApolloMed effected a merger with NMM (the “Merger”). The Merger closed and became effective on December 8, 2017 (the “Closing”) (see Note 3). As a result of the Merger, NMM is now a wholly-owned subsidiary of ApolloMed and the former NMM shareholders own a majority of the issued and outstanding common stock of ApolloMed. For accounting purposes, the Merger is treated as a “reverse acquisition,” and NMM is considered the accounting acquirer and ApolloMed is the accounting acquiree. Accordingly, as of the Closing, NMM’s historical results of operations replaced ApolloMed’s historical results of operations for all periods prior to the Merger, and the results of operations of both companies are included in the accompanying consolidated financial statements for all periods following the Merger. Effective as of the Closing, ApolloMed’s board of directors approved a change in ApolloMed’s fiscal year end from March 31 to December 31, to correspond with NMM’s fiscal year end prior to the Merger.

The combined company, following the Merger, together with its affiliated physician groups areand consolidated entities (collectively, the “Company”), is a physician-centric integrated population health management company working to provideproviding coordinated, outcomes-based medical care in a cost-effective manner. Ledmanner and serving patients in California, the majority of whom are covered by a management team with over a decade of experience, ApolloMed has built a company and culture that is focused on physicians providing high-quality medical care, population health management and care coordination for patients, particularly senior patients and patients with multiple chronic conditions. ApolloMed believes that the Company is well-positioned to take advantage of changes in the rapidly evolving U.S. healthcare industry, as there is a growing national movement towards more results-oriented healthcare centered on the triple aim of patient satisfaction, high-quality care and cost efficiency.

ApolloMed servesprivate or public insurance provided through Medicare, Medicaid and health maintenance organizationorganizations (“HMO”HMOs”) patients, and uninsured patients, in California. The Company primarily provides services to patients who are covered predominantly by private or public insurance, although the Company derives a. A small portion of itsthe Company’s revenue is generated from non-insured patients. The Company provides care coordination services to each major constituent of the healthcare delivery system, including patients, families, primary care physicians, specialists, acute care hospitals, alternative sites of inpatient care, physician groups and health plans.

ApolloMed’s The Company’s physician network consists of hospitalists, primary care physicians, and specialist physicians and hospitalists. The Company operates primarily through ApolloMed’s owned and affiliated physician groups. ApolloMed operates through itsthe following subsidiaries includingof ApolloMed: NMM, Apollo Medical Management, Inc. (“AMM”), Pulmonary CriticalAPA ACO, Inc. (“APAACO”) and Apollo Care Management,Connect, Inc. (“PCCM”Apollo Care Connect”), Verdugoand their consolidated entities.

NMM was formed in 1994 as a management service organization (“MSO”) for the purposes of providing management services to medical companies and independent practice associations (“IPAs”). The management services include primarily billing, collection, accounting, administrative, quality assurance, marketing, compliance and education.

Allied Physicians of California IPA, a Professional Medical Management,Corporation d.b.a. Allied Pacific of California IPA (“APC”) was incorporated on August 17, 1992 for the purpose of arranging health care services as an IPA. APC has contracts with various HMOs or licensed health care service plans as defined in the California Knox-Keene Health Care Service Plan Act of 1975. Each HMO negotiates a fixed amount per member per month (“PMPM”) that is to be paid to APC. In return, APC arranges for the delivery of health care services by contracting with physicians or professional medical corporations for primary care and specialty care services. APC assumes the financial risk of the cost of delivering health care services in excess of the fixed amounts received. Some of the risk is transferred to the contracted physicians or professional corporations. The risk is also minimized by stop-loss provisions in contracts with HMOs.

On July 1, 1999, APC entered into an amended and restated management and administrative services agreement with NMM for an initial fixed term of 30 years. In accordance with relevant accounting guidance, APC is determined to be a variable interest entity (“VIE”) of the Company as NMM is the primary beneficiary with the ability to direct the activities (excluding clinical decisions) that most significantly affect APC’s economic performance through its majority representation on the APC Joint Planning Board; therefore APC is consolidated by NMM. As of June 30, 2018 and December 31, 2017, APC had an ownership interest of 4.87% and 4.95% in ApolloMed, respectively.

Concourse Diagnostic Surgery Center, LLC (“CDSC”) was formed on March 25, 2010 in the state of California. CDSC is an ambulatory surgery center in City of Industry, California. Its facility is Medicare Certified and accredited by the Accreditation Association for Ambulatory Healthcare, Inc. During 2011, APC invested $625,000 for a 41.59% ownership interest in CDSC. APC’s ownership percentage in CDSC’s capital stock increased to 43.43% on July 31, 2016. CDSC is consolidated as a VIE by APC as it was determined that APC has a controlling financial interest in CDSC and is the primary beneficiary of CDSC.

APC also holds a 40% ownership interest in Pacific Ambulatory Surgery Center, LLC (“VMM”PASC”), a multi-specialty outpatient surgery center.

10

APC-LSMA was formed on October 15, 2012 as a designated shareholder professional corporation. Dr. Thomas Lam, a shareholder, Chief Executive and Financial Officer of APC and Co-CEO of ApolloMed, Palliative Services,is a nominee shareholder of APC. APC makes all the investment decisions on behalf of APC-LSMA, funds these investments and receives all the distributions from the investments. APC has the obligation to absorb losses or rights to receive benefits from all the investments made by APC-LSMA. APC-LSMA’s sole function is to act as the nominee shareholder for APC in other California medical professional corporations. Therefore, APC-LSMA is controlled and consolidated by APC who is the primary beneficiary of this VIE. The only activity of APC-LSMA is to hold the investments in medical corporations, including the IPA line of business of LaSalle Medical Associates (“LMA”), Pacific Medical Imaging and Oncology Center, Inc. (“PMIOC”), Diagnostic Medical Group (“DMG”) and AHMC International Cancer Center (“ICC”).

ICC was formed on September 2, 2010 in the state of California. ICC is a Professional Medical California Corporation and has entered into agreements with HMOs, IPAs, medical groups and other purchasers of medical services for the arrangement of services to subscribers or enrollees. On November 15, 2016, APC-LSMA, a holding company of APC, agreed to purchase and acquire from ICC 40% of the aggregate issued and outstanding shares of capital stock of ICC for $400,000 in cash. Certain requirements to complete the investment transaction was completed in August 2017 and effective on October 31, 2017, ICC was determined to be a VIE of APC and is consolidated by APC as it was determined that APC is the primary beneficiary of ICC through its obligation to absorb losses and right to receive benefits that could potentially be significant to ICC. The results of operations of ICC from October 31, 2017 to December 31, 2017 were de minimis.

Universal Care Acquisition Partners, LLC (“APS”UCAP”), a 100% owned subsidiary of APC, was formed on June 4, 2014, for the purpose of holding an investment in Universal Care, Inc. (“UCI”).

APAACO, jointly owned by NMM and AMM, began participating in the next generation accountable care organization model (“NGACO Model”) of the CMS in January 2017. The NGACO Model is a new CMS program that allows provider groups to assume higher levels of financial risk and potentially achieve a higher reward from participating in this new attribution-based risk sharing model. In addition to APAACO, NMM and AMM operated three accountable care organizations (“ACOs”) that participated in the Medicare Shared Savings Program (“MSSP”), with the goal of improving the quality of patient care and outcomes through more efficient and coordinated approach among providers. MSSP revenues are uncertain, and, if such amounts are payable by CMS, they will be paid on an annual basis significantly after the time earned, and are contingent on various factors, including achievement of the minimum savings rate for the relevant period. Such payments are earned and made on an “all or nothing” basis.

In 2012, ApolloMed formed an ACO, ApolloMed Accountable Care Organization, Inc. (“ApolloMed ACO”), and Apollo Care Connect, Inc. (“ApolloCare”). to participate in the MSSP.

 

ThroughOn November 11, 2015, NMM, ACO Acquisition Corporation, and APCN-ACO, A Medical Professional Corp. (“APCN-ACO”) entered into a reorganization agreement whereby ACO Acquisition Corporation, a newly organized entity in which NMM is its sole shareholder, merged with APCN-ACO, effective on January 8, 2016, resulting in APCN-ACO becoming a wholly owned subsidiary of NMM.

On December 18, 2016, NMM, ACO Acquisition Corporation #2, and Allied Physicians ACO, LLC (“AP-ACO”) entered into a reorganization agreement whereby ACO Acquisition Corporation #2, a newly organized entity in which NMM is its sole shareholder, merged into AP-ACO, effective on December 20, 2016, resulting in AP-ACO becoming a wholly owned subsidiary of NMM.

As the Company is transitioning to the NGACO Model, patients and physicians with the three ACOs have substantially been transferred to APAACO. ApolloMed ACO terminated its MSSP participation agreement with CMS on December 31, 2017. APCN-ACO terminated its MSSP participation agreement with CMS on December 31, 2017. AP-ACO terminated its MSSP participation agreement with CMS on December 31, 2016.

In conjunction with the Merger, ApolloMed sold to APC-LSMA all the issued and outstanding shares of capital stock of Maverick Medical Group, Inc. (“MMG”). MMG has historically been included in the consolidated financial statements filed by ApolloMed.

AMM, a wholly-owned subsidiary AMM,of ApolloMed, manages affiliated medical groups, which consist of ApolloMed Hospitalists (“AMH”), a hospitalist company, Maverick Medical Group, Inc. (“MMG”), AKM Medical Group, Inc. (“AKM”), Southern California Heart Centers (“SCHC”), Bay Area Hospitalist Associates A Medical Corporation (“BAHA”), a medical corporation, ApolloMed Care Clinic (“ACC”) and APA ACO,AKM Medical Group, Inc. (“APAACO”AKM”). Through itsAMH provides hospitalist, intensivist and physician advisor services. SCHC is a specialty clinic that focuses on cardiac care and diagnostic testing. BAHA, ACC and AKM are no longer active to any material extent.

11

Apollo Care Connect, a wholly-owned subsidiary PCCM,of ApolloMed, previously managed Los Angeles Lung Center (“LALC”) (see below for deconsolidation), and through its wholly-owned subsidiary VMM, ApolloMed previously managed Eli Hendel, M.D., Inc. (“Hendel”) (see below for deconsolidation). AMM, PCCM and VMM each operate as a physician practice management company and are in the business of providing management services to physician practice corporations under long-term management service agreements, pursuant to which AMM, PCCM or VMM, as applicable, manages all non-medical services for the affiliated medical group and has exclusive authority over all non-medical decision making related to ongoing business operations.

ApolloMed has a controlling interest in APS, which owns two Los Angeles-based companies, Best Choice Hospice Care LLC (“BCHC”) and Holistic Health Home Health Care Inc. (“HCHHA”).

ApolloMed also has a controlling interest in ApolloMed ACO, which participates in the Medicare Shared Savings Program (“MSSP”), the goal of which is to improve the quality of patient care and outcomes through more efficient and coordinated approach among providers. Revenues earned by ApolloMed ACO are uncertain, and, if such amounts are payable by the Centers for Medicare & Medicaid Services (“CMS”), they will be paid on an annual basis significantly after the time earned (which may take several years), and are contingent on various factors, including achievement of the minimum savings rate as determined by MSSP for the relevant period. Such payments are earned and made on an “all or nothing” basis. The Company considers revenue, if any, under the MSSP, as contingent upon the realization of program savings as determined by CMS, and are not considered earned and therefore are not recognized as revenue until notice from CMS that cash payments are to be imminently received. CMS determined that the Company did not meet the minimum savings threshold in performance year 2015 and 2016 and therefore shall not receive the “all or nothing” annual shared savings payment in fiscal years 2017 and 2018.

In January 2016, the Company formed ApolloCare, which acquired certain technology and other assets of Healarium, Inc., which provides the Company with a cloud and mobile-based population health management platform that includes digital care plans, a case management module, connectivity with multiple healthcare tracking devices and the ability to integrate with multiple electronic health records to capture clinical data.

 

During fiscal year 2016, the Company combined the operations of AKM into those of MMG.


In November 2016, BAHA Acquisition Corp., an affiliated entity owned by the Company’s CEO and consolidated asApolloMed also has a variable interest entity, acquired the non-controllingcontrolling interest in BAHAApollo Palliative Services, LLC (“APS”), which was previously consolidated as a variable interest entity,owns two Los Angeles-based companies, Best Choice Hospice Care, LLC (“BCHC”) and continues to have its financial results consolidated with thoseHolistic Care Home Health Agency, Inc. (“HCHHA”), each of the Company as a variable interest entity. As part of the transaction, the Company acquired the non-controlling interest of BAHA and was reflected as an equity transaction as there was no change in control.which provides palliative care services.

 

On December 21, 2016, the Company entered into an AgreementPulmonary Critical Care Management, Inc. (“PCCM”) and Plan of Merger (the “Merger Agreement”) among the Company, Apollo Acquisition Corp., a wholly-owned subsidiary of ours (“Merger Subsidiary”), NetworkVerdugo Medical Management, Inc. (“NMM”) and Kenneth Sim, M.D., in his capacity as the representative of the shareholders of NMM, pursuant to which NMM, one of the largest healthcare management services organizations in the United States that currently is responsible for coordinating the care for over 600,000 covered patients in Southern and Central California through a network of ten IPAs with over 4,000 contracted physicians, will merge into Merger Subsidiary (the “Merger”) and upon consummation of the Merger, NMM shareholders will receive such number of shares of the Company’s common stock (“Common Stock”) such that, after giving effect to the Merger and assuming there would be no dissenting NMM shareholders at the closing, NMM shareholders will own 82% of the total issued and outstanding shares of Common Stock at the closing of the Merger and the Company’s current stockholders will own the other 18% (the “Exchange Ratio”). Additionally, NMM agreed to relinquish its redemption rights relating to the Company’s Series A Preferred Stock that NMM owns.

On March 30, 2017, NMM, the Company and other relevant parties entered into an Amendment to the Merger Agreement (the “Merger Agreement Amendment No. 1”) to exclude, for purposes of calculating the Exchange Ratio, from “Parent Shares” (as defined in the Merger Agreement) 499,000 shares of Common Stock issued or issuable pursuant to a securities purchase agreement dated as of March 30, 2017, between the Company and Alliance Apex, LLC. As part the Merger Agreement Amendment, the merger consideration to be paid by the Company to NMM was amended to include warrants to purchase 850,000 shares of Common Stock at an exercise price of $11 per share in the closing of the proposed Merger. The waiting period under the Hart-Scott-Rodino Antitrust Improvements Act of 1976, as amended (“HSR”VMM”), with respect to the proposed Merger expired on July 7, 2017. The expiration of the HSR waiting period satisfies a condition to the closing of Merger. Consummation of the Merger, which remains subject to other conditions described in the Merger Agreement, including approvalwere operated by stockholders of the Company and the shareholders of NMM, is expected to take place in the second half of calendar year 2017. On August 10, 2017, NMM and the Company filed a registration statement on form S-4 with the Securities and Exchange Commission (the “SEC”) in connection with the proposed Merger. On October 17, 2017, the Company entered into a second amendment to the Merger Agreement (the “Merger Agreement Amendment No. 2”) (see Note 10 “Subsequent Events” below). The Merger Agreement Amendment No. 2 extended the “End Date” (as defined in the Merger Agreement) to March 31, 2018. Furthermore, pursuant to the Merger Agreement Amendment No. 2, upon consummation of the Merger (and assuming there will be no NMM dissenting shareholder interestsApolloMed as of the effective time of the Merger), in addition to receive such number of shares of Common Stock that represents 82% of the total issued and outstanding shares of Common Stock immediately following the consummation of the Merger and warrants to purchase 850,000 shares of Common Stock at an exercise price of $11 per share, NMM shareholders will be entitled to receive at the closing of the Merger an aggregate of 2,566,666 shares of Common Stock and warrants to purchase an aggregate of 900,000 shares of Common Stock exercisable at $10.00 per share. Pursuant to the Merger Agreement Amendment No. 2, NMM also agreed to provide an additional $4,000,000 working capital loan to the Company as evidenced by a promissory note in the principal amount of $9,000,000, which replaces the NMM Note in the principal amount of $5,000,000 (see Note 7 “Debt - Restated NMM Note” below) and is convertible into shares of Common Stock at a conversion price of $10.00 per share (subject to adjustment for stock splits, dividends, recapitalizations and the like) within 10 business days prior to maturity.

 On January 1, 2017 and March 24, 2017,physician practice management companies. PCCM and VMM amended the management services agreements that they entered into with LALC and Hendel, respectively, and among other things, reduced the scope of services to be provided by PCCM and VMM to align with the actual course of dealing between the parties. Based on the Company’s evaluation of current accounting guidance, it was determined that the Company no longer holds an explicit or implicit variable interest in these entities, and accordingly LALC and Hendel are no longer consolidated effective January 1, 2017 and their operations are not included in the March 31, 2017 and subsequent consolidated financial statements of the Company as of such date.

On January 18, 2017, CMS announced that APAACO, which is owned 50% by ApolloMed and 50% by NMM, has been approvedactive to participate in CMS’ Next Generation ACO Model (the “NGACO Model”). The NGACO Model is a new CMS program that builds upon previous ACO programs. Through this new model, CMS will partner with APAACO and other accountable care organizations (“ACOs”) experienced in coordinating care for populations of patients and whose provider groups are willing to assume higher levels of financial risk and potentially achieve a higher reward from participating in this new attribution-based risk sharing model. The NGACO program began on January 1, 2017. AMM, one of the Company’s wholly-owned subsidiaries, has a long-term management services agreement with APAACO. APAACO is consolidated as a variable interest entity by AMM as it was determined that AMM is the primary beneficiary of APAACO.

There are different levels of financial risk and reward that an ACO may select, and the extent of risk and reward may be limited on a percentage basis. The NGACO Model offers two risk arrangement options. In Arrangement A, the ACO takes 80% of Medicare Part A and Part B risk. In Arrangement B, the ACO takes 100% of Medicare Part A and Part B risk. Under each risk arrangement, the ACO can cap aggregate savings and losses anywhere between 5% to 15%. The cap is elected annually by the ACO. APAACO has opted for Risk Arrangement A and a shared savings and losses cap of 5%.


The NGACO Model offers four payment mechanisms:

·Payment Mechanism #1: Normal Fee For Service (“FFS”).
·Payment Mechanism #2: Normal FFS plus Infrastructure payments of $6 Per Beneficiary Per Month (“PBPM”).
·Payment Mechanism #3: Population-Based Payments (“PBP”). PBP payments provide ACOs with a monthly payment to support ongoing ACO activities. ACO participants and preferred providers must agree to percentage payment fee reductions, which are then used to estimate a monthly PBP payment to be received by the ACO.
·Payment Mechanism #4: All-Inclusive Population-Based Payment (“AIPBP”). Under this mechanism, CMS will estimate the total annual expenditures of the ACO’s aligned beneficiaries and pay that projected amount in PBPM payments. ACOs in AIPBP may have alternative compensation arrangements with their providers, including 100% FFS, discounted FFS, capitation or case rates.

APAACO began operations on January 1, 2017. APAACO opted for, and was approved by CMS effective on April 1, 2017 to participate in, the AIPBP track, which is the most advanced risk-taking payment model. APAACO is the only ACO that in the United States is participating in the AIPBP track, out of 44 ACOs approved for the NGACO Model. Under the AIPBP track, CMS will estimate the total annual expenditures for APAACO's patients and then pay that projected amount to APAACO in a per-beneficiary, per-month payment. APAACO will then be responsible for paying all Part A and Part B costs for in-network participating providers and preferred providers with whom it has contracted.

In connection with the approval by CMS for APAACO to participate in the NGACO Model, CMS and APAACO have entered into a NGACO Model Participation Agreement (the “Participation Agreement”), which was last modified on December 15, 2016. The term of the Participation Agreement is for two performance years, from January 1, 2017 through December 31, 2018. CMS may offer to renew the Participation Agreement for an additional term of two performance years. Additionally, the Participation Agreement may be terminated sooner by CMS as specified therein. Under the NGACO Model, CMS grants to APAACO a pool of patients to manage (direct care and pay providers) based on a budget negotiated with CMS. APAACO is responsible to manage medical costs for these patients to receive services from doctors and medical service providers as influenced by the Company. The Company earns revenues based on the negotiated contract terms with in-network providers. The Company’s profits or losses in managing the services provided by out-of-network providers are generally determined on an annual basis after reconciliation with CMS. The Company receives capitation from CMS on a monthly basis. Based on the Company’s efficiency or lack thereof, the Company’s profits/losses on providing such services are capped with CMS. The Company records the receipts from CMS as revenue as the Company is primarily responsible and liable for managing the costs incurred by the patients and to satisfy all provider obligations, assuming the credit risk through the arrangement with CMS, and controlling the funds, the services provided and the process by which the providers are ultimately paid. In October 2017, CMS notified APAACO that it has not been renewed for participation in the AIPBP payment mechanism of the NGACO Model for performance year 2018 due to certain alleged deficiencies in performance by APAACO. APAACO does not believe the allegations by CMS of performance deficiencies are valid or justify the CMS non-renewal determination and is in discussions with CMS regarding possible reversal of such determination. On November 9, 2017, APAACO submitted a request for reconsideration to CMS. If APAACO is not successful in convincing CMS to reverse its decision then the payment mechanism under the NGACO Model would default to traditional FFS. This would result in the loss in monthly revenues and cash flow currently being generated by APAACO, currently at a rate of approximately $9.3 million per month, and would thus have aany material adverse effect on ApolloMed’s future revenues and potential cash flow.

AMM has entered into a long-term Master Services Agreement with APAACO (the “APAACO MSA”). Under the APAACO MSA, AMM provides APAACO with care coordination, data analytics and reporting, technology and other administrative capabilities to enable participating providers to deliver better care and lower healthcare costs for their Medicare FFS beneficiaries. APAACO employs local operations and clinical staff to drive physician engagement and care coordination improvements.

Liquidity and Capital Resources

The accompanying condensed consolidated financial statements have been prepared assuming that the Company will continue as a going concern, which contemplates the realization of assets and settlement of liabilities in the normal course of business.

As shown in the accompanying unaudited condensed consolidated financial statements, the Company has incurred a net loss of approximately $8.1 million during the six months ended September 30, 2017, and, as of September 30, 2017, has a net working capital deficit of approximately $7.0 million and an accumulated deficit of approximately $45.1 million. The primary source of liquidity as of September 30, 2017 is cash and cash equivalents of approximately $30.2 million, which includes the capitation payments received from CMS, all or most of which will be used to pay the corresponding fee for service claims liability in future months.

These factors among others raise substantial doubt about the Company’s ability to continue as a going concern.

The ability of the Company to continue as a going concern is dependent upon the Company’s ability to increase revenue, reduce costs, attain a satisfactory level of profitability, obtain suitable and adequate financing, and further develop business. In addition, the Company may have to reduce certain overhead costs through the deferral of salaries and other means, and settle liabilities through negotiation. There can be no assurance that management’s plan and attempts will be successful.


The Company’s ability to continue as a going concern also depends, in significant part, on its ability to obtain the necessary financing to meet its obligations and pay the Company’s obligations arising from normal business operations as they come due. To date, the Company has funded the Company’s operations from a combination of internally generated cash flow and external sources, including the proceeds from the issuance of equity and/or debt securities. The Company is substantially dependent upon the consummation of the Merger to meet the Company’s liquidity requirements. The Company is currently exploring sources of additional funding. Without limiting its available options, future equity financings will most likely be through the sale of additional shares of its securities. It is possible that the Company could also offer warrants, options and/or rights in conjunction with any future issuances of its common stock. The Company’s current sources of revenues are insufficient to cover its operating costs, and as such, has incurred an operating loss since its inception. Thus, until the Company can generate sufficient cash flows to fund operations, the Company remains substantially dependent on raising additional capital through debt and/or equity transactions. There is no assurance that the proposed Merger will take place, or that any such additional financing will be available on favorable terms, or at all. If, after utilizing the existing sources of capital available to the Company, further capital needs are identified and the Company is not successful in obtaining the financing, it may be forced to curtail its existing or planned future operations.

The accompanying condensed consolidated financial statements do not include any adjustments relating to the recoverability and classification of recorded assets, or the amounts and classification of liabilities that might be necessary in the event that the Company cannot continue as a going concern.

Certain reclassifications have been made to comparative amounts in order to conform with current period presentation.extent.   

 

2.Basis of Presentation and Summary of Significant Accounting Policies

 

Basis of Presentation

 

The accompanying condensed consolidated balance sheet at MarchDecember 31, 2017, has been derived from audited consolidated financial statements. The unaudited condensed consolidated financial statements as of September 30, 2017 and for the six months ended September 30, 2017 and 2016, have been prepared in accordance withbut do not include all disclosures required by accounting principles generally accepted in the United States of America (“U.S. GAAP”). The accompanying unaudited condensed consolidated financial statements as of June 30, 2018 and for the three and six months ended June 30, 2018 and 2017, have been prepared in accordance with U.S. GAAP for interim financial information and with the instructions to Form 10-Q and Article 8 of Regulation S-X. Accordingly, they do not include all of the information and footnotes required by U.S. GAAP for complete financial statements, and should be read in conjunction with the audited consolidated financial statements and related footnotes included in the Company’s Annual Report on Form 10-K for the year ended MarchDecember 31, 2017 as filed with the SECU.S. Securities and Exchange Commission (“SEC”) on June 29, 2017.April 2, 2018. In the opinion of management, all material adjustments (consisting of normal recurring adjustments) considered necessary for a fair presentation have been made in the condensed consolidated financial statements. The condensed consolidated financial statements include all material adjustments (consisting of normal recurring accruals) necessary to make the condensed consolidated financial statements not misleading as required by Regulation S-X, Rule 10-01. The Company’s quarterly results fluctuate. Operating results for the three and six months ended SeptemberJune 30, 20172018 are not necessarily indicative of the results that may be expected for the year ending MarchDecember 31, 2018.2018 or any future periods.

 

Principles of Consolidation

 

The Company’s condensed consolidated financial statements includebalance sheets as of December 31, 2017 and June 30, 2018, includes the accounts of ApolloMed, its consolidated subsidiaries NMM, including NMM’s subsidiaries, APCN-ACO and AP-ACO, AMM, APAACO and Apollo Medical Holdings, Inc.Care Connect, NMM’s consolidated VIE, APC, APC’s subsidiary, UCAP, and allAPC’s consolidated VIEs, CDSC, APC-LSMA and ICC. The condensed consolidated statement of income for the three and six months ended June 30, 2017, includes NMM, its whollyconsolidated VIE, APC, APC’s subsidiary, UCAP, and majority ownedAPC’s consolidated VIEs, CDSC, APC-LSMA and ICC. The condensed consolidated statement of income for the three and six months ended June 30, 2018, includes ApolloMed, its consolidated subsidiaries as well as all variable interest entities where it is the primary beneficiary, including physician practice corporations (“PPCs”) managed by aNMM, AMM, APAACO and Apollo Care Connect, NMM’s consolidated VIE, APC, APC’s subsidiary, of the Company under long-term management services agreements (“MSAs”), under which the subsidiary providesUCAP, and performs all non-medical managementAPC’s consolidated VIEs, CDSC, APC-LSMA and administrative services. Through the MSAs, the Company generally has exclusive authority over all non-medical decision making related to the ongoing business operations of the PPCs. Therefore, the Company typically consolidates the revenue and expenses of a PPC from the date of execution of the applicable MSA. Each MSA typically has a term from 10 to 20 years and is not terminable by the respective PPC (except for a limited number of situations such asICC.

All material breach by or bankruptcy of the other party). Because, as explained in Note 1, effective on January 1, 2017, the Company no longer holds an explicit or implicit variable interest in LALC and Hendel, the two PPCs are not consolidated as of such date. All intercompany balances and transactions have been eliminated.eliminated in consolidation.

 

Business Combinations

 

The Company uses the acquisition method of accounting for all business combinations, which requires assets and liabilities of the acquiree to be recorded at fair value, to measure the fair value of the consideration transferred, including contingent consideration, to be determined on the acquisition date, and to account for acquisition related costs separately from the business combination.

Reportable Segments

 

The Company operates as one reportable segment, the healthcare delivery segment. Whilesegment, and implements and operates innovative health care models to create a patient-centered, physician-centric experience. The Company reports its condensed consolidated financial statements in the Company has determined it has six reporting units, such reporting units do not meet the quantitative threshold underaggregate, including all activities in one reportable segment.

Use of Estimates

The preparation of condensed consolidated financial statements and related disclosures in conformity with U.S. GAAP requires management to be considered a reportable segment. As such, these reporting unitsmake estimates and all related activities are aggregated into a single reportable segment inassumptions that affect the Company’sreported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the condensed consolidated financial statements.statements and the reported amounts of revenues and expenses during the reporting period. Significant items subject to such estimates and assumptions include collectability of receivables, recoverability of long-lived and intangible assets, business combination and goodwill valuation and impairment, accrual of medical liabilities (including incurred, but not reported (“IBNR”) claims), determination of full-risk and shared-risk revenue and receivable (including constraints, completion factors and the modified retrospective adjustments), income taxes and valuation of share-based compensation. Management evaluates its estimates and assumptions on an ongoing basis using historical experience and other factors, including the current economic environment, and makes adjustments when facts and circumstances dictate. As future events and their effects cannot be determined with precision, actual results could differ materially from those estimates and assumptions.

 

11 

12

 

 

Revenue RecognitionReclassifications

 

Revenue consists of contracted, fee-for-service, capitation, MSSP ACO, hospitalist agreements, and NGACO revenue. Revenue is recordedCertain amounts disclosed in prior period financial statements have been reclassified to conform to the current period in which services are rendered. Revenue is principally derived from the provision of healthcare staffing services to patients within healthcare facilities and ACO management. The form of billing and related risk of collection for such services may vary by customer. The following is a summary of the principal forms ofpresentation. These reclassifications had no effect on the Company’s billing arrangements and howreported revenue, net revenue is recognized for each.income, cash flows or total assets.

 

Contracted revenue

Contracted revenue represents revenue generated under contracts for which the Company provides physicianCash and other healthcare staffing and administrative services in return for a contractually negotiated fee. Contract revenue consists primarily of billings based on hours of healthcare staffing provided at agreed-to hourly rates. Revenue in such cases is recognized as the hours are worked by the Company’s staff and contractors. Additionally, contract revenue also includes supplemental revenue from hospitals where the Company may have a fee-for-service contract arrangement or provide physician advisory services to the medical staff at a specific facility. Contract revenue for the supplemental billing in such cases is recognized based on the terms of each individual contract. Such contract terms generally either provide for a fixed monthly dollar amount or a variable amount based upon measurable monthly activity, such as hours staffed, patient visits or collections per visit compared to a minimum activity threshold. Such supplemental revenues based on variable arrangements are usually contractually fixed on a monthly, quarterly or annual calculation basis considering the variable factors negotiated in each such arrangement. Such supplemental revenues are recognized as revenue in the period when such amounts are determined to be fixed and therefore contractually obligated as payable by the customer under the terms of the respective agreement. Additionally, the Company derives a portion of the Company’s revenue as a contractual bonus from collections received by the Company’s partners and such revenue is contingent upon the collection of third-party billings. These revenues are not considered earned and therefore not recognized as revenue until actual cash collections are achieved in accordance with the contractual arrangements for such services.

Fee-for-service revenueCash Equivalents

Fee-for-service revenue represents revenue earned under contracts in which the Company bills and collects the professional component of charges for medical services rendered by the Company’s contracted physicians. Under the fee-for-service arrangements, the Company bills patients for services provided and receives payment from patients or their third-party payors. Fee-for-service revenue is reported net of contractual allowances and policy discounts. All services provided are expected to result in cash flows and are therefore reflected as net revenue in the consolidated financial statements. Fee-for-service revenue is recognized in the period in which the services are rendered to specific patients and reduced immediately for the estimated impact of contractual allowances in the case of those patients having third-party payor coverage. The recognition of net revenue (gross charges less contractual allowances) from such visits is dependent on such factors as proper completion of medical charts following a patient visit, the forwarding of such charts to the Company’s billing center for medical coding and entering into the Company’s billing system and the verification of each patient’s submission or representation at the time services are rendered as to the payor(s) responsible for payment of such services. Revenue is recorded based on the information known at the time of entering of such information into the Company’s billing systems as well as an estimate of the revenue associated with medical services.

Capitation revenue

Capitation revenue (net of capitation withheld to fund risk share deficits) is recognized in the month in which the Company is obligated to provide services. Minor ongoing adjustments to prior months’ capitation, primarily arising from contracted HMOs finalizing monthly patient eligibility data for additions or subtractions of enrollees, are recognized in the month they are communicated to the Company. Managed care revenues of the Company consist primarily of capitated fees for medical services provided by the Company under a provider service agreement (“PSA”) or capitated arrangements directly made with various managed care providers including HMOs and management service organizations. Capitation revenue under the PSA and HMO contracts is prepaid monthly to the Company based on the number of enrollees electing the Company as their healthcare provider. Additionally, Medicare pays capitation using a “Risk Adjustment model,” which compensates managed care organizations and providers based on the health status (acuity) of each individual enrollee. Health plans and providers with higher acuity enrollees will receive more and those with lower acuity enrollees will receive less. Under Risk Adjustment, capitation is determined based on health severity, measured using patient encounter data. Capitation is paid on an interim basis based on data submitted for the enrollee for the preceding year and is adjusted in subsequent periods after the final data is compiled. Positive or negative capitation adjustments are made for Medicare enrollees with conditions requiring more or less healthcare services than assumed in the interim payments. Since the Company cannot reliably predict these adjustments, periodic changes in capitation amounts earned as a result of Risk Adjustment are recognized when those changes are communicated by the health plans to the Company. Additionally, Medicare pays capitation using a “Risk Adjustment Model,” which compensates managed care organizations and providers based on the health status (acuity) of each individual enrollee. Health plans and providers with higher acuity enrollees will receive more and those with lower acuity enrollees will receive less. Under Risk Adjustment, capitation is determined based on health severity, measured using patient encounter data. Capitation is paid on an interim basis based on data submitted for the enrollee for the preceding year and is adjusted in subsequent periods after the final data is compiled. Positive or negative capitation adjustments are made for Medicare enrollees with conditions requiring a different level of healthcare services than assumed in making the interim payments. In prior years, periodic changes in capitation amounts earned as a result of Risk Adjustment were recognized when those changes were communicated by the health plans to the Company. Starting in fiscal year 2017, the Company started to record the estimated amount that it expects to be received from Medicare for Risk Adjustment based on its current data, instead of the initially received capitation, as part of revenue. The Company does not believe that this change resulted in a material change in the amount of revenue recognized.


HMO contracts also include provisions to share in the risk for enrollee hospitalization, whereby the Company can earn additional incentive revenue or incur penalties based upon the utilization of hospital services. Typically, any shared risk deficits are not payable until and unless the Company generates future risk sharing surpluses, or if the HMO withholds a portion of the capitation revenue to fund any risk share deficits. At the termination of the HMO contract, any accumulated risk share deficit is typically extinguished. Due to the lack of access to information necessary to estimate the related costs, shared-risk amounts receivable from the HMOs are only recorded when such amounts are known. Risk pools for the prior contract years are generally final settled in the third or fourth quarter of the following fiscal year.

In addition to risk-sharing revenues, the Company also receives incentives under “pay-for-performance” programs for quality medical care, based on various criteria. These incentives are generally recorded in the third and fourth quarters of the fiscal year and recorded when such amounts are known.

Under full risk capitation contracts, an affiliated hospital enters into agreements with several HMOs, pursuant to which, the affiliated hospital provides hospital, medical, and other healthcare services to enrollees under a fixed capitation arrangement (“Capitation Arrangement”). In addition, under a risk pool sharing agreement, the affiliated hospital and a medical group agree to establish a Hospital Control Program to serve the enrollees, pursuant to which, the medical group is allocated a percentage of the profit or loss, after deductions for costs to the affiliated hospital. The Company typically participates in full risk programs under the terms of a PSA, with health plans whereby the Company is wholly liable for the deficits allocated to the medical group under the arrangement. The related liability is included in medical liabilities in the accompanying consolidated balance sheets as of September 30, 2017 and March 31, 2017. See “Medical Liabilities” below.

Medicare Shared Savings Program Revenue

 

The Company, through its subsidiary ApolloMed ACO, participates in the MSSP, which is sponsored by CMS. The goalCompany’s cash and cash equivalents primarily consist of the MSSP is to improve the qualitymoney market funds and certificates of patient care and outcomes through more efficient and coordinated approach among providers. The MSSP allows ACO participants to share in cost savings it generates in connection with rendering medical services to Medicare patients. Payments to ACO participants, if any, will be calculated annually by CMS on cost savings generated by the ACO participant relative to the ACO participants’ cost savings benchmark. The MSSP is a program managed by CMS that has an evolving payment methodology. Revenues earned by ApolloMed ACO are uncertain, and, if such amounts are payable by the CMS, they will be paid on an annual basis significantly after the time earned (which may take several years), and will be contingent on various factors, including achievement of the minimum savings rate as determined by MSSP for the relevant period. Such payments are earned and made on an “all or nothing” basis.deposit. The Company considers revenue, if any, under the MSSP, as contingent upon the realization of program savings as determined by CMS, and are not considered earned and therefore are not recognized as revenue until notice from CMS that cash payments are to be imminently received.

Hospitalist Agreements

During fiscal year 2017, the Company entered into several hospitalist agreements with hospitals, whereby the Company earns a stipend fee plus a fee based on an agreed percentage of fee-for-service collections. The fee is recorded at an amount net of the portion owed to the hospitals (the Company collects all fees on behalf of the hospitals). The fee revenue is further reduced by a portion subject to quality metrics which is only recorded as revenue upon the Company meeting these metrics. The Company considered the indicators of gross revenue and net revenue reporting under ASC 605-45-45, “Revenue Recognition: Principal Agent Considerations” and determined that revenue from this arrangement is recorded at net.

Next Generation Accountable Care Organization Revenue

Under the NGACO Model, CMS grants APAACO, which is jointly owned by the Company and NMM, a pool of patients to manage (direct care and pay providers) based on a budget established with CMS. APAACO is responsible to manage medical costs for these patients. The patients will receive services from physicians and other medical service providershighly liquid investments that are both in-networkreadily convertible into known amounts of cash and out-of-network. The Company receives capitationmature within ninety days from CMS on a monthly basis to pay claims from in-network providers. The Company records such capitation received from CMS as revenue as the Company is primarily responsible and liable for managing the patient care and to satisfy provider obligations, is assuming the credit risk for the services provided by in-network providers through its arrangement with CMS, and has control of the funds, the services provided and the process by which the providers are ultimately paid. Claims from out-of-network providers are generally processed or paid by CMS and the Company’s profits or losses in managing the services provided by out-of-network providers are generally determined on an annual basis after reconciliation with CMS. Pursuant to the Company’s risk share agreement with CMS, the Company will be eligible to receive the surplus or be liable for the deficit according to the budget established by CMS based on the Company’s efficiency or lack thereof, respectively, in managing how the patients assigned to APAACO by CMS are served by in-network and out-of-network providers. The Company’s profits or losses on providing such services are both capped by CMS. The Company will recognize such surplus or deficit upon substantial completion of reconciliation and determination of the amounts. In accordance with ASC 605-45-45, “Revenue Recognition: Principal Agent Considerations” the Company records such revenues on the gross basis. 


The Company also has arrangements for billing and payment services with the medical providers within the NGACO network. The Company retains certain defined percentages of the payments made to the providers in exchange for using the Company’s billing and payment services. The revenue for this service is earned as payments are made to medical providers.

For each performance year, APAACO shall submit to CMS its selections for risk arrangement; the amount of a savings/loss cap; alternative payment mechanism; benefits enhancements, if any; and its decision regarding voluntary alignment under the NGACO Model. APAACO must obtain CMS consent before voluntarily discontinuing any benefit enhancement during a performance year.

For each performance year, CMS shall pay APAACO in accordance with the alternative payment mechanism, if any, for which CMS has approved APAACO; the risk arrangement for which APAACO has been approved by CMS; and as otherwise provided in the Participation Agreement. Following the end of each performance year, and at such other times as may be required under the Participation Agreement, CMS will issue a settlement report to APAACO setting forth the amount of any shared savings or shared losses and the amount of other monies owed. If CMS owes APAACO shared savings or other monies owed, CMS shall pay the ACO in full within 30 days after the date on which the relevant settlement report is deemed final, except as provided in the Participation Agreement. If APAACO owes CMS shared losses or other monies owed as a result of a final settlement, APAACO shall pay CMS in full within 30 days after the relevant settlement report is deemed final. If APAACO fails to pay the amounts due to CMS in full within 30 days after the date of a demand letter or settlement report, CMS shall assess simple interest on the unpaid balance at the rate applicable to other Medicare debts under current provisions of law and applicable regulations. In addition, CMS and the U.S. Department of the Treasury may use any applicable debt collection tools available to collect any amounts owed by APAACO.

In October 2017, CMS notified APAACO that it has not been renewed for participation in the AIPBP payment mechanism of the NGACO Model for performance year 2018 due to certain alleged deficiencies in performance by APAACO. APAACO does not believe the allegations by CMS of performance deficiencies are valid or justify the CMS non-renewal determination and is in discussions with CMS regarding possible reversal of such determination. On November 9, 2017, APAACO submitted a request for reconsideration to CMS. If APAACO is not successful in convincing CMS to reverse its decision then the payment mechanism under the NGACO Model would default to traditional FFS. This would result in the loss in monthly revenues and cash flow currently being generated by APAACO, currently at a rate of approximately $9.3 million per month, and would thus have a material adverse effect on ApolloMed’s future revenues and potential cash flow.

Cash and Cash Equivalents

Cash and cash equivalents consists of highly liquid investments with an initial maturity of three months or less attheir date of purchase to be cash equivalents.

 

The Company maintains its cash in deposit accounts with several banks, which at times may exceed the insured limits of the Federal Deposit Insurance Corporation (“FDIC”). The Company believes it is not exposed to any significant credit risk with respect to its cash, cash equivalents and restricted cash. As of June 30, 2018, the Company’s deposit accounts with banks exceeded the FDIC’s insured limit by approximately $134.8 million. The Company has not experienced any losses to date and performs ongoing evaluations of these financial institutions to limit the Company’s concentration of risk exposure.

Restricted Cash

 

At times, APC is required to maintain a reserve fund by certain health plans, which are held in certificate of deposit accounts with initial maturities of six months from the date of purchase and interest rates ranging from 0.05% to 0.10%. Restricted cash primarilyalso consists of cash held as collateral to secure standby letters of credits as required by certain contracts. As of June 30, 2018 and December 31, 2017, there was $8,040,870 and $18,005,661 included in restricted cash short-term, respectively, in the accompanying condensed consolidated balance sheets. Approximately $8,000,000 and $18,000,000 of such restricted cash as of June 30, 2018 and December 31, 2017, respectively, was related to an amount that, as a result of the Merger between ApolloMed and NMM (see Note 3), will be held in an escrow account for distribution to former NMM shareholders.

 

Accounts Receivable and Allowance for Doubtful AccountsReceivables

 

AccountsThe Company’s receivables are comprised of accounts receivable, primarily consists of amounts due from third-party payors, including government sponsored Medicarecapitation and Medicaid programs, insurance companies,claims receivable, risk pool settlements and amounts due from hospitalsincentive receivables, management fee income and patients.other receivables. Accounts receivable are recorded and stated at the amount expected to be collected.

 

Capitation and claims receivable relate to a health plan’s capitation, which is received by the Company in the month following the month of service. Risk pool settlements and incentive receivables mainly consist of the Company’s full risk pool receivable that is recorded in accordance with Financial Accounting Standards Board (“FASB”) Accounting Standards Codification (“ASC”) 606 (see Note 13). Other receivables include fee-for-services (“FFS”) reimbursement for patient care, certain expense reimbursements, transportation reimbursements from hospitals and stop loss insurance premium reimbursements from IPAs.

The Company maintains reserves for potential credit losses on accounts receivable. The CompanyManagement reviews the composition of accounts receivable and analyzes historical bad debts, customer concentrations, customer credit worthiness, current economic trends and changes in customer payment patterns to evaluate the adequacy of these reserves. The Company also regularly analyzes the ultimate collectability of accounts receivable after certain stages of the collection cycle using a look-back analysis to determine the amount of receivables subsequently collected and adjustments are recorded when necessary. Reserves are recorded primarily on a specific identification basis.

 

ConcentrationsAmounts are recorded as a receivable when the Company is able to determine amounts receivable under applicable contracts and/or agreements based on information provided and collection is reasonably likely to occur. The Company continuously monitors its collections of receivables and its policy is to write off receivables when they are determined to be uncollectible. The Company has not incurred credit losses related to receivables. As of June 30, 2018 and December 31, 2017, the Company recorded an allowance for doubtful accounts of $725,356 and $407,953, respectively.

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Major

Concentrations of Risks

The Company had major payors that contributed the following percentage of net revenue of the Company included:revenue:

 

  Three Months Ended
September 30,
  Six Months Ended
September 30,
 
  2017  2016  2017  2016 
Governmental - Medicare/Medi-Cal  73%  21.9%  72.5%  22.6%
L.A Care  *%  *%  *%  11.9%
Allied Physicians  *%  *%  *%  11.3%

  For the Three Months
Ended June 30,
 
  2018  2017 
       
Payor A  *%  13.4%
Payor B  15.4%  17.5%
Payor C  *%  12.0%
Payor D  *%  12.1%

* Represents lessLess than 10% of total net revenues

 


  For the Six Months
Ended June 30,
 
  2018  2017 
       
Payor A  *%  13.1%
Payor B  13.7%  20.8%
Payor C  *%  11.9%
Payor D  10.2%  12.4%

Receivables from

   * Less than 10% of total net revenues

The Company had major payors amountedthat contributed to the following percentage of total accounts receivable:receivables before the allowance for doubtful accounts:

 

  September 30,
2017
  

March 31,

2017

 
Governmental - Medicare/Medi-Cal  24.3%  20.5%
Allied Physicians  12.5%  12.8%

  As of
June 30, 2018
  As of
December 31, 2017
 
       
Payor E  21.6%  23.8%
Payor F  32.5%  30.5%
Payor G  14.1%  *%

* Less than 10% of receivables

Fair Value Measurements of Financial Instruments

 

The increaseCompany’s financial instruments consist of cash and cash equivalents, fiduciary cash, restricted cash, investment in government revenue ismarketable securities, receivables, loans receivable, derivative asset (warrants), accounts payable, certain accrued expenses, capital lease obligations, bank loan and the line of credit. The carrying values of the financial instruments classified as current in the accompanying consolidated balance sheets are considered to be at their fair values, due to APAACO’s new NGACO contractthe short maturity of these instruments. The carrying amount of the loan receivables – long term, bank loan, capital lease obligations and line of credit approximates fair value as they bear interest at rates that approximate current market rates for debt with CMSsimilar maturities and credit quality.

FASB ASC 820,Fair Value Measurement (“ASC 820”), applies to all financial assets and financial liabilities that are measured and reported on a fair value basis and requires disclosure that establishes a framework for measuring fair value and expands disclosure about fair value measurements. ASC 820 establishes a fair value hierarchy for disclosures of the inputs to valuations used to measure fair value.

This hierarchy prioritizes the inputs into three broad levels as follows:

Level 1 —Inputs are unadjusted quoted prices in active markets for identical assets or liabilities that can be accessed at the measurement date.

Level 2 —Inputs include quoted prices for similar assets and liabilities in active markets, quoted prices for identical or similar assets or liabilities in markets that are not active, inputs other than quoted prices that are observable for the asset or liability (i.e., interest rates and yield curves), and inputs that are derived principally from or corroborated by observable market data by correlation or other means (market corroborated inputs).

Level 3 —Unobservable inputs that reflect assumptions about what market participants would use in pricing the asset or liability. These inputs would be based on the best information available, including the Company’s own data.

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The carrying amounts and fair values of the Company’s financial instruments as of June 30, 2018 are presented below:

  Fair Value Measurements    
  Level 1  Level 2  Level 3  Total 
Assets                
Money market funds* $75,345,074  $-  $-  $75,345,074 
Marketable securities – certificates of deposit  1,061,022   -   -   1,061,022 
Marketable securities – equity securities  69,945   -   -   69,945 
                 
Total $76,476,041  $-  $-  $76,476,041 

The carrying amounts and fair values of the Company’s financial instruments as of December 31, 2017 are presented below:

  Fair Value Measurements    
  Level 1  Level 2  Level 3  Total 
Assets                
Money market funds* $41,231,405  $-  $-  $41,231,405 
Marketable securities – certificates of deposit  1,057,090   -   -   1,057,090 
Marketable securities – equity securities  86,005   -   -   86,005 
                 
Total $42,374,500  $-  $-  $42,374,500 

*Included in cash and cash equivalents

There were no Level 3 inputs measured on a recurring basis for the six months ended June 30, 2018. The following summarizes activity of Level 3 inputs measured on a recurring basis for the three and six months ended June 30, 2017:

  Derivative
Assets
(Warrants)
 
    
Balance at April 1, 2017 $4,072,222 
Change in fair value of warrant liabilities  1,394,443 
Balance at June 30, 2017 $5,466,665 

  Derivative
Assets
(Warrants)
 
    
Balance at January 1, 2017 $5,338,886 
Change in fair value of warrant liabilities  127,779 
Balance at June 30, 2017 $5,466,665 

The fair value of the warrant derivative asset of approximately $55.7$5.5 million that went into effectat June 30, 2017 was estimated using the Black-Scholes valuation model, using the following inputs: term of 3.29 – 3.75 years, risk free rate of 1.50% - 1.60%, no dividends, volatility of 38.9% - 39.1%, share price of $10.00 per share based on the trading price of ApolloMed’s common stock adjusted for a marketability discount, and a 0% probability of redemption of the warrant shares issued along with the shares of ApolloMed’s convertible preferred stock issued in the first quarterfinancing.

There have been no changes in Level 1, Level 2, or Level 3 classification and no changes in valuation techniques for these assets for the six months ended June 30, 2018 and 2017.

Intangible Assets and Long-Lived Assets

Intangible assets with finite lives include network-payor relationships, management contracts and member relationships and are stated at cost, less accumulated amortization and impairment losses. These intangible assets are amortized on the accelerated method using the discounted cash flow rate.

Intangible assets with finite lives also include a patent management platform as well as trade names and trademarks, whose valuations were determined using the cost to recreate method and the relief from royalty method, respectively. These assets are stated at cost, less accumulated amortization and impairment losses and are amortized using the straight-line method.

Finite-lived intangibles and long-lived assets are reviewed for impairment whenever events or changes in circumstances indicate that the carrying amount of an asset may not be recoverable. If the expected future cash flows from the use of such assets (undiscounted and without interest charges) are less than the carrying value, a write-down would be recorded to reduce the carrying value of the asset to its estimated fair value. Fair value is determined based on appropriate valuation techniques. The Company determined that there was no impairment of its finite-lived intangible or long-lived assets during the six months ended June 30, 2018 and 2017.

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Goodwill and Indefinite-Lived Intangible Assets

Under the ASC 350,Intangibles – Goodwill and Other (“ASC 350”), goodwill and indefinite-lived intangible assets are reviewed at least annually for impairment.

At least annually, at the Company’s fiscal year 2018.end, management assesses whether there has been any impairment in the value of goodwill by first comparing the fair value to the net carrying value of the reporting unit. The Company has determined it has four reporting units, which are comprised of (1) provider services, (2) management services, (3) IPA, and (4) ACO. If the carrying value exceeds its estimated fair value, a second step is performed to compute the amount of the impairment. An impairment loss is recognized if the implied fair value of the asset being tested is less than its carrying value. In this event, the asset is written down accordingly. The fair values of goodwill are determined using valuation techniques based on estimates, judgments and assumptions management believes are appropriate in the circumstances.

At least annually, indefinite-lived intangible assets are tested for impairment. Impairment for intangible assets with indefinite lives exists if the carrying value of the intangible asset exceeds its fair value. The fair values of indefinite-lived intangible assets are determined using valuation techniques based on estimates, judgments and assumptions management believes are appropriate in the circumstances. The Company determined that there was no impairment of its goodwill during the six months ended June 30, 2018 and 2017.

Investments in Other Entities - Equity Method

 

The Company maintains its cash and cash equivalents and restricted cash in bank deposit accounts which, at times, may exceed federally insured limits. Thefor certain investments using the equity method of accounting when it is determined that the investment provides the Company with the ability to exercise significant influence, but not control, over the investee. Significant influence is generally deemed to exist if the Company has not experienced any lossesan ownership interest in such accounts; however, amounts in excessthe voting stock of the federally insured limit may beinvestee of between 20% and 50%, although other factors, such as representation on the investee’s board of directors, are considered in determining whether the equity method of accounting is appropriate. Under the equity method of accounting, the investment, originally recorded at risk ifcost, is adjusted to recognize the bank experiences financial difficulties. Approximately $32.9 million was in excessCompany’s share of net earnings or losses of the Federal Deposit Insurance Corporation limitsinvestee and is recognized in the accompanying consolidated statements of $250,000 per depositor as of Septemberincome under “Income (loss) from equity method investments” and also is adjusted by contributions to and distributions from the investee. Equity method investments are subject to impairment evaluation. No impairment loss was recorded on equity method investments for the six months ended June 30, 2018 and 2017.

 

The Company’s business and operations are concentrated in one state, California. Any material changes by California with respect to strategy, taxation and economics of healthcare delivery, reimbursements, financial requirements or other aspects of regulation of the healthcare industry could have an adverse effect on the Company’s operations and cost of doing business.Medical Liabilities

 

Medical Liabilities

The Company isAPC, APAACO and MMG are responsible for integrated care that the associated physicians and contracted hospitals provide to its enrollees under risk-pool arrangements. The Company providesenrollees. APC, APAACO and MMG provide integrated care to health planHMOs, Medicare and Medi-Cal enrollees through a network of contracted providers under sub-capitation and direct patient service arrangements, company-operated clinics and staff physicians.arrangements. Medical costs for professional and institutional services rendered by contracted providers are recorded as cost of services expenses in the accompanying consolidated statements of operations. Costs for operating medical clinics, including the salaries of medical personnel, are also recorded in cost of services, while non-medical personnel and support costs are included in general and administrative expense.income.

  

An estimate of amounts due to contracted physicians, hospitals, and other professional providers is included in medical liabilities in the accompanying consolidated balance sheets. Medical liabilities include claims reported as of the balance sheet date and estimates of incurred but not reported claims (“IBNR”).IBNR claims. Such estimates are developed using actuarial methods and are based on manynumerous variables, including the utilization of health care services, historical payment patterns, cost trends, product mix, seasonality, changes in membership, and other factors. As APAACO’s NGACO program is new and no sufficient claims history is not available, the medical liabilities for the NGACO program are estimated and bookedrecorded at 100% of the revenue less actual claims processed for or paid to in-network providers (after taking into account the average discount negotiated with the in-network providers). The Company plans to use the traditional lag models as the claims history matures. The estimation methods and the resulting reserves are periodically reviewed and updated. Many of the medical contracts are complex in nature and may be subject to differing interpretations regarding amounts due for the provision of various services. Such differing interpretations may not come to light until a substantial period of time has passed following the contract implementation.

Revenue Recognition

On January 1, 2018, the Company adopted the new revenue recognition standard Accounting Standards Update (“ASU”) 2014-09, “Revenue from Contracts with Customers (Topic 606)”, using the modified retrospective method. Modified retrospective adoption requires entities to apply the standard retrospectively to the most current period presented in the financial statements, requiring the cumulative effect of the retrospective application as an adjustment to the opening balance of retained earnings and noncontrolling interests at the date of initial application. Revenue from substantially all of the Company’s contracts with customers continues to be recognized over time as services are rendered. The Company2017 comparative information has not been restated and continues to be reported under the accounting standards in effect for that period. Refer to Note 13 - Revenue Recognition for further details.

Income Taxes

Federal and state income taxes are computed at currently enacted tax rates less tax credits using the asset and liability method. Deferred taxes are adjusted both for items that do not have tax consequences and for the cumulative effect of any changes in tax rates from those previously used to determine deferred tax assets or liabilities. Tax provisions include amounts that are currently payable, changes in deferred tax assets and liabilities that arise because of temporary differences between the timing of when items of income and expense are recognized for financial reporting and income tax purposes, changes in the recognition of tax positions and any changes in the valuation allowance caused by a $20,000 per member professional stop-loss and $200,000 per member stop-loss for Medi-Cal patientschange in institutional risk pools. Any adjustmentsjudgment about the realizability of the related deferred tax assets. A valuation allowance is established when necessary to reserves are reflected in current operations.reduce deferred tax assets to amounts expected to be realized.

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The Company’s medical liabilities were as follows:

  Six Months
Ended September 30, 2017
  Year Ended
March 31,
2017
 
Balance, beginning of period $1,768,231  $2,670,709 
Incurred health care costs:        
Current year  60,445,600   10,365,502 
Claims paid:        
Current year  (30,685,463)  (8,524,215)
Prior years  (1,829,866)  (1,881,869)
Total claims paid  (32,515,329)  (10,406,084)
Risk pool settlement  -   814,733 
Accrual for net surplus (deficit) from full risk capitation contracts  995,671   (1,676,629)
         
Balance, end of period $30,694,173  $1,768,231 


Deferred Financing Costs

The Company’s costs relatingCompany uses a recognition threshold of more-likely-than-not and a measurement attribute on all tax positions taken or expected to debt issuance have been deferred and are amortized over the lives of the respective loans, using the effective interest method and is recorded as interest expensebe taken in a tax return in order to be recognized in the condensed consolidated statementsfinancial statements. Once the recognition threshold is met, the tax position is then measured to determine the actual amount of operations.benefit to recognize in the financial statements.

During the six months ended September 30, 2017 and 2016, the Company’s amortization of debt issuance costs amounted to approximately $107,000 and $38,000, respectively.

Stock-BasedShare-Based Compensation

 

The Company maintains a stock-based compensation program for employees, non-employees, directors and consultants, which is more fully described in Note 6.consultants. The value of stock-based awards so measuredsuch as options is recognized as compensation expense on a cumulative straight-line basis over the vesting terms of the awards, adjusted for forfeitures as they occur. Theexpected forfeitures. At times, the Company sells certainissues shares of its restricted common stock to its employees, directors and consultants, with awhich shares may be subject to the Company’s repurchase right (but not obligation) of repurchase feature that lapses based on performance of services in the future.

 

The Company accounts for share-based awards granted to persons other than employees and directors under ASC 505-50Equity-Based Payments to Non-Employees. As such the fair value of such shares of stock is periodically re-measured using an appropriate valuation model and income or expense is recognized over the vesting period.

 

Fair Value of Financial InstrumentsBasic and Diluted Earnings Per Share

 

The Company’s accounting for Fair Value Measurement and Disclosures defines fair value as the exchange price that would be received for an asset or paid to transfer a liability (an exit price) in the principal or most advantageous market for the asset or liability in an orderly transaction between market participants on the measurement date. This topic also establishes a fair value hierarchy which requires classification based on observable and unobservable inputs when measuring fair value. The fair value hierarchy distinguishes between assumptions based on market data (observable inputs) and an entity’s own assumptions (unobservable inputs). The hierarchy consists of three levels:

Level one — Quoted market prices in active markets for identical assets or liabilities;

Level two — Inputs other than level one inputs that are either directly or indirectly observable; and

Level three — Unobservable inputs developed using estimates and assumptions, which are developed by the reporting entity and reflect those assumptions that a market participant would use.

Determining which category an asset or liability falls within the hierarchy requires significant judgment. The Company evaluates its hierarchy disclosures each quarter.

The carrying amount reported in the accompanying condensed consolidated balance sheets for cash and cash equivalents, accounts receivable, accounts payable and accrued expenses approximates fair value because of the short-term maturity of those instruments. The carrying amount for borrowings under the lines of credit approximate fair value which is determined by using interest rates that are available for similar debt obligations with similar terms at the balance sheet date.

Warrant liabilities

In October 2015, the Company issued a stock purchase warrant (the “Series A Warrant”) to NMM in connection with its purchase of the Company’s Series A convertible preferred stock (the “Series A Preferred Stock”) (see Note 6), which initially required liability classification. The fair value of the warrant liabilities of approximately $2.8 million at March 31, 2016, was estimated using the Monte Carlo valuation model, using the following inputs: term of 4.5 years, risk free rate of 1.13%, no dividends, volatility of 65.7%, share price of $5.93Basic earnings per share based on the trading price(“EPS”) is computed by dividing net income attributable to holders of the Company’s common stock adjusted for marketability discount, and a 0% probabilityby the weighted average number of redemption of the warrant shares issued along with the shares of the Series A Preferred Stock issued to NMM in October 2015. The fair value of the warrant liabilities of approximately $1.5 million as of September 30, 2016, was estimated using the Monte Carlo valuation model which used the following inputs: term of 4.04 years, risk free rate of 0.99%, no dividends, volatility of 61.7%, share price of $4.50 per share based on the trading price of the Company’s common stock adjusted for a marketability discount. As of September 30, 2017 and March 31, 2017,outstanding during the Company’s outstanding warrants did not require liability classification.

There was no financial instrument measured at fair value on a recurring basis as of September 30, 2017 and March 31, 2017.

There was no Level 3 input measured on a recurring basis in the three months ended September 30, 2017. The following summarizes activity of Level 3 inputs measured on a recurring basis in the six months ended September 30, 2016:

  Warrant
Liability
 
    
Balance at March 31, 2016 $2,811,111 
Gain on change in fair value of warrant liabilities  (1,333,333)
Balance at September 30, 2016 $1,477,778 


The gain on change in fair value of the warrant liabilities of $1,333,333 for the six months ended September 30, 2016 is included in the accompanying condensed consolidated statement of operations. As there was no warrant liability at either March 31, 2017 or September 30, 2017, there is no change in the fair value of warrant liabilities for the six months ended September 30, 2017.

Non-controlling Interests

The non-controlling interests recorded in the Company’s consolidated financial statements includes the equity of PPCs in which the Company has determined that it has a controlling financial interest and for which consolidation is required as a result of management contracts entered into with these entities owned by third-party physicians. The nature of these contracts provide the Company with a monthly management fee to provide the services described above, and as such, the adjustments to non-controlling interests in any period subsequent to initial consolidation would relate to either capital contributions or distributions by the non-controlling parties as well as income or losses attributable to certain non-controlling interests. Non-controlling interests also represent third-party minority equity ownership interests which are majority owned by the Company.

Basic andperiods presented. Diluted Earnings per Share

Basic net income (loss)earnings per share is calculatedcomputed using the weighted average number of shares of the Company’s common stock issued andoutstanding plus the effect of dilutive securities outstanding during the periods presented, using treasury stock method. Refer to Note 10 for a certaindiscussion of shares treated as treasury shares for accounting purposes.

The basic EPS for the comparative period (the three and issix months ended June 30, 2017) before the closing of the Merger (see Note 3) presented in the condensed consolidated financial statements was calculated by dividing net income (loss)(a) by the weighted average number of shares of the Company’s common stock issued and outstanding during such period. Diluted net income (loss) per share is calculated using the weighted average number of common and potentially dilutive common shares outstanding during the period, using the as-if converted method for secured convertible notes, preferred stock, and the treasury stock method for options and warrants.(b):

 

a)The income of the legal acquiree (NMM) attributable to holders of the Company’s common stock in such period.

b)The legal acquiree’s historical weighted average number of shares of common stock outstanding multiplied by the exchange ratio established in the Merger.

Noncontrolling Interests

The following table sets forthCompany consolidates entities in which the approximate numberCompany has a controlling financial interest. The Company consolidates subsidiaries in which the Company holds, directly or indirectly, more than 50% of the voting rights, and VIEs in which the Company is the primary beneficiary. Noncontrolling interests represent third-party equity ownership interests (including certain VIEs) in the Company’s consolidated entities. The amount of net income attributable to noncontrolling interests is disclosed in the consolidated statements of income.

Mezzanine Equity

Pursuant to APC’s shareholder agreements, in the event of a disqualifying event, as defined in the agreements, APC could be required to repurchase the shares excluded from the computationrespective shareholders based on certain triggers outlined in the shareholder agreements. As the redemption feature of diluted earnings per share,the shares is not solely within the control of APC, the equity of APC does not qualify as their inclusion would be anti-dilutive:

  Three Months Ended
September 30,
  Six Months Ended 
September 30,
 
  2017  2016  2017  2016 
Preferred Stock  1,666,666   1,666,666   1,666,666   1,666,666 
Options  1,019,850   487,500   1,099,850   527,500 
Warrants  169,500   104,500   1,295,611   114,500 
Convertible Notes  514,093   -   514,093   - 
   3,370,109   2,258,666   4,576,220   2,308,666 

New Accounting Pronouncementspermanent equity and has been classified as mezzanine or temporary equity. Accordingly, the Company recognizes noncontrolling interests in APC as mezzanine equity in the condensed consolidated financial statements.

 

Recent Accounting Pronouncements

In February 2016,May 2014, the FASB issued ASU 2016-02, LeasesNo. 2014-09, “Revenue from Contracts with Customers (Topic 606)” (“ASU 2016-02”2014-09”). This new standard establishesASU 2014-09 and other subsequent revisions amend the guidance for revenue recognition to replace numerous, industry specific requirements and converges areas under this topic with those of the International Financial Reporting Standards. The ASU implements a right-of-use (ROU) modelfive-step process for customer contract revenue recognition that focuses on transfer of control, as opposed to transfer of risk and rewards. The amendment also requires a lessee to record a ROU assetenhanced disclosures regarding the nature, amount, timing and a lease liability onuncertainty of revenues and cash flows from contracts with customers. Other major provisions include the balance sheet for all leases with terms longer than 12 months. Leases will be classified as either finance or operating, with classification affectingcapitalization and amortization of certain contract costs, ensuring the patterntime value of expense recognitionmoney is considered in the income statement. ASU 2016-02 is effective for fiscal years beginning after December 15, 2018, including interim periods within those fiscal years. Early adoption is permitted. A modified retrospectivetransaction price, and allowing estimates of variable consideration to be recognized before contingencies are resolved in certain circumstances. Entities can transition approach is required for lessees for capital and operating leases existing at,to the standard either retrospectively or entered into after, the beginningas a cumulative-effect adjustment as of the earliest comparative period presented in the financial statements, with certain practical expedients available. The Company is currently evaluating the impactdate of the adoption of ASU 2016-02 on the consolidated financial statements.

In March 2016, the FASB issued ASU 2016-09, Compensation - Stock Compensation (Topic 718): Improvements to Employee Share-Based Payment Accounting (“ASU 2016-09”). This ASU makes several modifications to Topic 718 related to the accounting for forfeitures, employer tax withholding on share-based compensation, and the financial statement presentation of excess tax benefits or deficiencies. With respect to the accounting for forfeitures, ASU 2016-09 allows an entity to elect as an accounting policy either to continue to estimate the total number of awards for which the requisite service period will not be rendered (as currently required) or to account for forfeitures when they occur. This entity-wide accounting policy election only applies to service conditions; for performance conditions, the entity continues to assess the probability that such conditions will be achieved. An entity must also disclose its policy election for forfeitures. ASU 2016-09 also clarifies the statement of cash flows presentation for certain components of share-based awards. The standard is effective for interim and annual reporting periods beginning after December 15, 2016, with early adoption permitted.adoption. The Company adopted this guidanceASU 2014-09 on AprilJanuary 1, 2017 and chose the option2018. Refer to accountNote 13 “Revenue Recognition”, for forfeitures as they occur. Such adoption did not have a material impact on the Company’s consolidated financial statements and related disclosures.further details.

 


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In January 2016, the FASB issued ASU No. 2016-01, Financial“Financial Instruments - Overall (Topic 825-10): Recognition and Measurement of Financial Assets and Financial LiabilitiesLiabilities” (“ASU 2016-01”). ASU 2016-01 addresses certain aspects of recognition, measurement, presentation and disclosures of financial instruments including the requirement to measure certain equity investments at fair value with changes in fair value recognized in net income. The Company adopted ASU 2016-01 on January 1, 2018. The adoption of ASU 2016-01 did not have a material impact on the Company’s condensed consolidated financial statements.

In February 2016, the FASB issued ASU No. 2016-02, “Leases (Topic 842)” (“ASU 2016-02”). Under ASU 2016-02, lessees will be required to recognize the following for all leases (with the exception of short-term leases) at the commencement date: a lease liability, which is a lessee’s obligation to make lease payments arising from a lease, measured on a discounted basis; and a right-of-use asset, which is an asset that represents the lessee’s right to use, or control the use of, a specified asset for the lease term. In July 2018, the FASB issued ASU No. 2018-11. The amendments in this update provide entities with an additional (and optional) transition method to adopt the new leases standard. Under this new transition method, an entity initially applies the new leases standard at the adoption date and recognize a cumulative-effect adjustment to the opening balance of retained earnings in the period of adoption. Consequently, an entity’s reporting for the comparative periods presented in the financial statements in which it adopts the new leases standard will continue to be in accordance with current GAAP. An entity that elects this additional (and optional) transition method must provide the required Topic 840 disclosures for all periods that continue to be in accordance with Topic 840. The Company does not expect to early adopt the new guidance. The Company has appointed a project team and is in the process of evaluating the impact the new standard will have on its condensed consolidated financial statements. The Company expects to complete the impact assessment process by the end of the third quarter of 2018, and to complete the implementation process, including adding procedures and evaluating necessary disclosures, prior to the end of the first quarter of 2019. 

In June 2016, the FASB issued ASU No. 2016-13, “Financial Instruments-Credit Losses (Topic 326)-Measurement of Credit Losses on Financial Instruments” (“ASU 2016-13”). The new standard requires entities to measure all expected credit losses for financial assets held at the reporting date based on historical experience, current conditions and reasonable and supportable forecasts. ASU 2016-13 will become effective for the Company on April 1, 2018.fiscal years beginning after December 15, 2019, with early adoption permitted. The Company is currently evaluating the guidance to determineimpact ASU 2016-13 will have on the potential impact on itscondensed consolidated financial condition, results of operations, cash flows and financial statement disclosures.

Recently, the FASB issued the following accounting standard updates related to ASU 2014-09 (Topic 606),Revenue Contracts with Customers:

·ASU No. 2014-09, Revenue from Contracts with Customers (Topic 606) (“ASU 2014-09”) in May 2014. ASU 2014-09 requires entities to recognize revenue through the application of a five-step model, which includes identification of the contract, identification of the performance obligations, determination of the transaction price, allocation of the transaction price to the performance obligations and recognition of revenue as the entity satisfies the performance obligations.
·ASU No. 2016-08, Revenue from Contracts with Customers (Topic 606): Principal versus Agent Considerations (Reporting Revenue Gross versus Net) (“ASU 2016-08”) in March 2016. ASU 2016-08 does not change the core principle of revenue recognition in Topic 606 but clarifies the implementation guidance on principal versus agent considerations.
·ASU No. 2016-10, Revenue from Contracts with Customers (Topic 606): Identifying Performance Obligations and Licensing (“ASU 2016-10”) in April 2016. ASU 2016-10 does not change the core principle of revenue recognition in Topic 606 but clarifies the implementation guidance on identifying performance obligations and the licensing implementation guidance, while retaining the related principles for those areas.
·ASU No. 2016-11, Revenue Recognition (Topic 605) and Derivatives and Hedging (Topic 815): Rescission of SEC Guidance Because of Accounting Standards Updates 2014-09 and 2014-16 Pursuant to Staff Announcements at the March 3, 2016 EITF Meeting (SEC Update) (“ASU 2016-11”) in May 2016. ASU 2016-11 rescinds SEC paragraphs pursuant to two SEC Staff Announcements at the March 3, 2016 EITF meeting. The SEC Staff is rescinding SEC Staff Observer comments that are codified in Topic 605 and Topic 932, effective upon adoption of Topic 606.
·ASU No. 2016-12, Revenue from Contracts with Customers (Topic 606): Narrow-Scope Improvements and Practical Expedients in May 2016. ASU 2016-12 does not change the core principle of revenue recognition in Topic 606 but clarifies the implementation guidance on a few narrow areas and adds some practical expedients to the guidance.
·ASU No. 2016-20, Revenue from Contracts with Customers (Topic 606): Technical Corrections and Improvements (“ASU 2016-20”) in December 2016. ASU 2016-20 does not change the core principle of revenue recognition in Topic 606 but summarizes the technical corrections and improvements to ASU 2014-09 and is effective upon adoption of Topic 606.

These ASUs will become effective for the Company on April 1, 2018. The Company currently anticipates adopting the standard using the modified retrospective method. The Company has begun the process of implementing this standard, including performing a review of its revenue streams to identify any differences in the timing, measurement, or presentation of revenue recognition. The Company currently believes that the primary impact will be changes to the timing of recognition of revenues related to fee-for-service and enhanced financial statement disclosures. The Company will continue to assess the impact on all areas of its revenue recognition, disclosure requirements and changes that may be necessary to its internal controls over financial reporting.statements.

 

In August 2016, the FASB issued ASU No. 2016-15, Statement“Statement of Cash Flows (Topic 230) – Classification of Certain Cash Receipts and Cash PaymentsPayments” (“ASU 2016-15”). This ASU provides clarification regarding how certain cash receipts and cash payments are presented and classified in the statement of cash flows. This ASU addresses eight specific cash flow issues with the objective of reducing the existing diversity in practice. The issues addressed in this ASU that will affect the Company are classifying debt prepayments or debt extinguishment costs and contingent consideration payments made after a business combination. This update is effective for annual and interim periods beginning after December 15, 2017, and interim periods within that reporting period. Early adoption is permitted. The Company is currently assessing the impact theadopted ASU 2016-15 on January 1, 2018. The adoption of ASU 2016-15 willdid not have a material impact on the Company’s condensed consolidated financial statements.

 

In December 2016, the FASB issued ASU No. 2016-18, Statement“Statement of Cash Flows (Topic 230) – Restricted Cash” (“ASU 2016-18”). The amendments in ASU 2016-18 require that a statement of cash flows explain the change during the period in the total of cash, cash equivalents, and amounts generally described as restricted cash or restricted cash equivalents. The Company adopted ASU 2016-17 will become effective2016-18 on January 1, 2018. As a result of adopting ASU 2016-18, the primary impact to the condensed consolidated statements of cash flows relates to including amounts generally described as restricted cash in cash and cash equivalents when reconciling beginning-of-period and end-of-period total amounts shown on the statements of cash flows. Also, prior period amounts in the statements of cash flows for the Company on April 1, 2018. Early adoption is permitted, including adoption in an interim period. The Company is currently assessing the impactsix months ended June 30, 2017 have been retrospectively adjusted to reflect the adoption of ASU 2016-18 will have on the Company’s consolidated financial statements.2016-18.

 

In January 2017, the FASB issued ASU No. 2017-01, Business“Business Combinations (Topic 805): Clarifying the Definition of a BusinessBusiness” (“ASU 2017-01”). This ASU provides a screen to determine when an asseta set is not a business, which requires that when substantially all of the fair value of the gross assets acquired (or disposed of) is concentrated in a single identifiable asset or a group of similar identifiable assets, the set is not a business, which reduces the number of transactions that need to be further evaluated. If the screen is not met, this ASU requirerequires that to be considered a business, a set muchmust include, at a minimum, an input and a substantive process that together significantly contribute to the ability to create output and also remove the evaluation of whether a market participant could replace missing elements. This update is effective for annual and interim periods beginning after December 15, 2017, including interim periods within those periods. The Company is currently assessing the impact theadopted ASU 2017-01 on January 1, 2018. The adoption of ASU 2017-01 willdid not have a material impact on the Company’s condensed consolidated financial statements.

 


In January 2017, the FASB issued ASU No. 2017-04, Intangibles“Intangibles – Goodwill and Other (Topic 350): Simplifying the Test for Goodwill ImpairmentImpairment” (“ASU 2017-04”). This ASU eliminates Step 2 from the goodwill impairment test if the carrying amount exceeds the fair value of a reporting unit and also eliminated the requirements for any reporting unit with a zero or negative carrying amount to perform a qualitative assessment and, if it fails that qualitative test, to perform Step 2 of the goodwill impairment test. Therefore, the same impairment assessment applies to all reporting units. An entity is required to disclose the amount of goodwill allocated to each reporting unit with a zero or negative carrying amount of net assets. This update is effective for annual and interim periods beginning after December 15, 2019. Early adoption is permitted for interim or annual goodwill impairment tests performed on testing dates after January 1, 2017. The Company is currently assessing the impact the adoption of ASU 2017-04 will have on the Company’s condensed consolidated financial statements.

18

 

In May 2017, the FASB issued ASU No. 2017-09, Compensation –“Compensation - Stock Compensation (Topic 718): Scope of Modification AccountingAccounting” (“ASU 2017-09”). This ASU provide guidance about, to clarify which changes to the terms or conditions of a share-based payment award require an entity to apply modification accounting in Topic 718. This updateASU is effective for all entities for annual periods, and interim periods within those annual periods beginning after December 15, 2017. Early adoption is permitted, including adoption in any interim period, for public business entities for reporting periods for which financial statements have not yet been issued. The amendments in this update shouldASU 2017-09 will be applied prospectively when changes to anthe terms or conditions of a share-based payment award modified on or after the adoption date,occur. The Company is currently assessing the impact theadopted ASU 2017-01 on January 1, 2018. The adoption of ASU 2017-09 willdid not have a material impact on the Company’s condensed consolidated financial statements.

 

In July 2017, the FASB issued ASU No. 2017-11, Earnings“Earnings Per Share (Topic 260); Distinguishing Liabilities from Equity (Topic 480); Derivatives and Hedging (Topic 815): (Part 1) Accounting for Certain Financial Instruments with Down Round Features, (Part II) Replacement of the Indefinite Deferral for Mandatorily Redeemable Financial Instruments of Certain Nonpublic Entities and Certain Mandatorily Redeemable Non-controlling Interests with a Scope ExceptionException” (“ASU 2017-11”). The amendments in Part I of this Update change the classification analysis of certain equity-linked financial instruments (or embedded features) with down round features. When determining whether certain financial instruments should be classified as liabilities or equity instruments, a down round feature no longer precludes equity classification when assessing whether the instrument is indexed to an entity’s own stock. The amendments also clarify existing disclosure requirements for equity-classified instruments. The amendments in Part 1 of this update are effective for fiscal years, and interim periods within those fiscal years, beginning after December 15, 2018. Early adoption is permitted, including adoption in any interim period. If an entity early adopts the amendments in an interim period, any adjustments should be reflected as of the beginning of the fiscal year that includes that interim period. The Company is currently assessing the impact the adoption of ASU 2017-11 will have on the Company’s condensed consolidated financial statements.

 

Use of Estimates

The preparation of financial statements in conformity with U.S. GAAP requiresWith the Company to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the dateexception of the new standards discussed above, there have been no other new accounting pronouncements that have significance, or potential significance, to the Company’s financial statementsposition, results of operations and the reported amounts of revenues and expenses during the reporting period. Actual results may materially differ from these estimates under different assumptions or conditions.cash flows.

 

3.Intangible AssetsMergers and Acquisitions

 

On December 8, 2017, (the “Effective Time”) the Merger of ApolloMed’s wholly-owned subsidiary, Apollo Acquisition Corp., with and into NMM as the surviving entity was completed, in accordance with the terms and conditions of the Agreement and Plan of Merger, dated as of December 21, 2016 (as amended on March 30, 2017 and October 17, 2017), by and among the Company, Merger Sub, NMM and Kenneth Sim, M.D., in his capacity as the NMM shareholders’ representative. As a result of the Merger, NMM now is a wholly-owned subsidiary of ApolloMed and former NMM shareholders own a majority of the issued and outstanding common stock of the Company. Both companies are considered to be a business under the guidance outlined in ASC 805, Business Combinations. The combined company operates under the Apollo Medical Holdings name. NMM is the larger entity in terms of assets, revenues and earnings. In addition, as of the closing of the Effective Time, the majority of the board of directors of the combined company was comprised of former NMM directors and directors nominated for election by NMM. Accordingly, ApolloMed is considered to be the legal acquirer (and accounting acquiree), NMM is considered to be the accounting acquirer (and legal acquiree), and the merger transaction is considered a reverse acquisition. As a result, as of the Effective Time, NMM’s historical results of operations replaced ApolloMed’s historical results of operations for all periods prior to the Merger, and the results of operations of both companies will be included in the Company’s financial statements for all periods following the Merger. As of the Effective Time, the Company’s board of directors approved a change in the Company’s fiscal year end from March 31 to December 31, to correspond with NMM’s fiscal year end prior to the Merger.

Pursuant to the Merger Agreement, at the Effective Time, each issued and outstanding share of NMM common stock converted into the right to receive (i) such number of fully paid and nonassessable shares of ApolloMed’s common stock that resulted in the NMM shareholders having a right to receive an aggregate number of shares of ApolloMed’s common stock that represented 82% of the total issued and outstanding shares of ApolloMed common stock immediately following the Effective Time, with no NMM dissenting shareholder interests as of the Effective Time (the “exchange ratio”), plus (ii) an aggregate of 2,566,666 shares of ApolloMed’s common stock, with no NMM dissenting shareholder interests as of the Effective Time, and (iii) common stock warrants to purchase a pro-rata portion of an aggregate of 850,000 shares of common stock of ApolloMed, exercisable at $11.00 per share and warrants to purchase an aggregate of 900,000 shares of common stock of ApolloMed at $10.00 per share. At the Effective Time, pre-Merger ApolloMed stockholders held their existing shares of ApolloMed’s common stock. At the Effective Time, ApolloMed held back 10% of the total number of shares of ApolloMed’s common stock issuable to pre-Merger NMM shareholders in the Merger to secure indemnification of ApolloMed and its affiliates under the Merger Agreement. Separately, indemnification of pre-Merger NMM shareholders under the Merger Agreement was made by the issuance by ApolloMed to pre-Merger NMM shareholders of new additional shares of common stock (capped at the same number of shares of ApolloMed’s common stock as are subject to the holdback for the indemnification of ApolloMed). These holdback shares will be held for a period of up to 24 months after the closing of the Merger (to be distributed on a pro-rata basis to former NMM shareholders), during which ApolloMed may seek indemnification for any breach of, or noncompliance with, any provision of the Merger agreement, by NMM. Half of these shares will be issued on the first and second anniversary of the Effective Time respectively.

For purposes of calculating the exchange ratio, (A) the aggregate number of shares of ApolloMed common stock held by the NMM shareholders immediately following the Effective Time excluded (i) any shares of ApolloMed common stock owned by NMM shareholders immediately prior to the Effective Time, (ii) the Series A warrant and Series B warrant issued by ApolloMed to NMM to purchase ApolloMed common stock (the “ApolloMed Warrants”) and (iii) any shares of ApolloMed common stock issued or issuable to NMM shareholders pursuant to the exercise of the ApolloMed Warrants, and (B) the total number of issued and outstanding shares of ApolloMed common stock immediately following the Effective Time excluded 520,081 shares of ApolloMed common stock issued or issuable under a Convertible Promissory Note to Alliance Apex, LLC (“Alliance”) for $4.99 million and accrued interest pursuant to the Securities Purchase Agreement between ApolloMed and Alliance dated as of March 30, 2017.

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The consideration for the transaction was 18% of the total issued and outstanding shares of ApolloMed common stock, or 6,109,205 shares (immediately following the Merger).

In addition, the fair value of NMM’s 50% interest in APAACO, an entity that was owned 50% by ApolloMed and 50% by NMM, was remeasured at fair value as of the Effective Time and added to the consideration transferred to ApolloMed as a result of NMM relinquishing its equity investment in APAACO in order to obtain control of ApolloMed. The fair value of NMM’s noncontrolling interest in APAACO has been estimated to be $5,129,000.

Total estimated purchase consideration consisted of the following:

Equity consideration (1) $61,092,050 
Estimated fair value of ApolloMed preferred stock held by NMM (2)  19,118,000 
Estimated fair value of NMM’s noncontrolling interest in APAACO (3)  5,129,000 
Estimated fair value of the outstanding ApolloMed stock options (4)  1,055,333 
Total estimated purchase consideration $86,394,383 

(1)Equity consideration

Immediately following the Effective Time, pre-Merger ApolloMed stockholders continued to hold an aggregate of 6,109,205 shares of ApolloMed common stock.

The equity consideration, which represents a portion of the consideration deemed transferred to the pre-Merger ApolloMed stockholders in the Merger, is calculated based on the number of shares of the combined company that the pre-Merger ApolloMed stockholders would own as of the closing of the Merger.

Number of shares of the combined company that would be owned by pre-Merger ApolloMed stockholders(1)    6,109,205 
Multiplied by the price per share of ApolloMed’s common stock(2)   $10.00 
Equity consideration $61,092,050 

(1)Represents the number of shares of the combined company that pre-Merger ApolloMed stockholders would own at closing of the Merger.

(2)Represents the closing price of ApolloMed’s common stock on December 8, 2017.

(2)Estimated fair value of ApolloMed’s preferred shares held by NMM

NMM currently owns all the shares of ApolloMed Series A preferred stock and Series B preferred stock, which was acquired prior to the Merger. As part of the Merger, the ApolloMed Series A preferred stock and Series B preferred stock is remeasured at fair value and included as part of the consideration transferred to ApolloMed. The fair value of the Series A preferred stock and Series B preferred stock is reflective of the liquidation preferences, claims of priority and conversion option values thereof. In aggregate, the Series A and Series B preferred stock were valued to be $19,118,000. The valuation methodology was based on an Option Pricing Method (“OPM”) which utilized the observable publicly traded common stock price in valuing the Series A preferred stock and the Series B preferred stock within the context of the capital structure of the Company. OPM assumptions included an expected term of 2 years, volatility rate of 37.9%, and a risk-free rate of 1.8%.  The fair value of the liquidation preference for the Series A preferred stock and the Series B preferred stock was determined to be $12,745,000 and the fair value of the conversion option was determined to be $6,373,000 or an aggregate total fair value of $19,118,000.

(3)Estimated fair value of NMM’s 50% share of APA ACO Inc.

Prior to the Merger, APAACO was owned 50% by ApolloMed and 50% NMM. NMM’s noncontrolling interest in APAACO has been remeasured at fair value as of the closing date and is added to the consideration transferred to ApolloMed as a result of NMM relinquishing its equity investment in APAACO in order to obtain control of ApolloMed. The fair value of NMM’s noncontrolling interest in APAACO has been estimated to be $5,129,000 using the discounted cash flow method and NMM recorded a gain on investment for the same amount to reflect the fair value of this investment prior to the Merger.

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(4)Estimated fair value of the ApolloMed outstanding stock options

The estimated fair value of the outstanding ApolloMed stock options is included in consideration transferred in accordance with ASC 805. The outstanding ApolloMed stock options are expected to vest in conjunction with the Merger due to a pre-existing change-of-control provision associated with the awards. There is no future service requirement.

Under the acquisition method of accounting, the identifiable assets acquired and liabilities assumed of ApolloMed, the accounting acquiree, are recorded at the Merger date fair values and added to those of NMM, the accounting acquirer. The following table sets forth the preliminary allocation of the purchase consideration to the identifiable tangible and intangible assets acquired and liabilities assumed of ApolloMed and MMG (see “MMG Transaction” below), with the excess recorded as goodwill:

Assets acquired   
Cash and cash equivalents $36,367,555 
Accounts receivable, net  7,261,588 
Other receivables  3,211,028 
Prepaid expenses  249,193 
Property, plant and equipment, net  1,114,332 
Restricted cash  745,220 
Fair value of intangible assets acquired  14,984,000 
Deferred tax assets  2,498,417 
Other assets  217,241 
Total assets acquired $66,648,574 
Liabilities assumed    
Accounts payable and accrued liabilities $8,632,893 
Medical liabilities  39,353,540 
Line of credit  25,000 
Convertible note payable, net  5,376,215 
Convertible note payable - related party  9,921,938 
Noncontrolling interest  3,142,000 
Total liabilities assumed and noncontrolling interest $66,451,586 
Net assets acquired $196,988 
Goodwill $86,197,395 

Goodwill is not deductible for tax purposes.

During the six months ended June 30, 2018, goodwill related to the Merger increased by $671,555 due to the $868,000 increase in the estimated fair value of the outstanding ApolloMed stock options, which amount was partially offset by the $196,445 increase in the related deferred tax asset with a commensurate adjustment recorded to additional paid in capital. In addition, during the six months ended June 30, 2018, goodwill and deferred tax assets decreased by $914,011 resulting from an adjustment associated with the allocation of the Merger transaction costs. As a result, in the aggregate, during the six months ended June 30, 2018, goodwill decreased by $242,456.

The purchase consideration and purchase price allocation are preliminary and subject to change as more information becomes available, which will be finalized as soon as practicable within the measurement period of no later than one year following the Effective Time of the Merger.

MMG Transaction

In conjunction with the Merger, ApolloMed sold to APC-LSMA all the issued and outstanding shares of capital stock of MMG. MMG has historically been included in the consolidated financial statements filed by ApolloMed. APC-LSMA agreed to pay $100 in consideration for all the shares of MMG. As the transaction is between related parties, the purchase consideration of MMG reflected in the purchase price allocation was determined to be the fair value of MMG. MMG and AMM terminated the existing Management Services Agreement between them and APC-LSMA paid AMM $400,000 as a termination payment on the Effective Time. APC-LSMA is consolidated by APC which in turn is consolidated by NMM, and as a result, the $400,000 amount is eliminated upon consolidation.

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Pro Forma Combined Historical Results

The pro forma combined historical results, as if ApolloMed had been acquired as of January 1, 2017, are estimated as follows (unaudited):

  Three Months
Ended
June 30, 2017
 
Net revenues $121,725,058 
Net loss attributable to Apollo Medical Holdings, Inc. $(1,755,268)
Weighted average common shares outstanding:    
Basic  33,601,022 
Earnings per share:    
basic $(0.05)
Weighted average common shares outstanding:    
diluted  33,601,022 
Earnings per share:    
diluted $(0.05)

  Six Months
Ended
June 30, 2017
 
Net revenues $220,192,318 
Net loss attributable to Apollo Medical Holdings, Inc. $(2,107,249)
Weighted average common shares outstanding:    
Basic  33,601,022 
Earnings per share:    
basic $(0.06)
Weighted average common shares outstanding:    
diluted  33,601,022 
Earnings per share:    
diluted $(0.06)

The pro forma information has been prepared for comparative purposes only and does not purport to be indicative of what would have occurred had the acquisition actually been made at such date, nor is it necessarily indicative of future operating results.

4.Intangible Assets, Net

At June 30, 2018, the Company’s intangible assets, net, consisted of the following:

  Useful  Gross     Net 
  Life  June 30,  Accumulated  June 30, 
  (Years)  2018  Amortization  2018 
Indefinite Lived Assets:                
Medicare license  N/A  $1,994,000  $-  $1,994,000 
Amortized Intangible Assets:                
Network relationships  11-15   109,883,000   (42,332,259)  67,550,741 
Management contracts  15   22,832,000   (6,278,801)  16,553,199 
Member relationships  12   6,696,000   (668,084)  6,027,916 
Patient management platform  5   2,060,000   (240,333)  1,819,667 
Tradename/trademarks  20   1,011,000   (29,487)  981,513 
      $144,476,000  $(49,548,964) $94,927,036 

At December 31, 2017, the Company’s intangible assets, net, consisted of the following:

 

  Weighted  Gross     Net 
  Average  September 30,  Accumulated  September 30, 
  Life (Yrs.)  2017  Amortization  2017 
Indefinite Lived Assets:                
Medicare License  N/A  $704,000  $-  $704,000 
                 
Amortized Intangible Assets:                
Acquired Technology  5   1,312,500   (393,750)  918,750 
Network Relationships  5   220,000   (139,333)  80,667 
Trade Name  5   102,000   (72,433)  29,567 
      $2,338,500  $(605,516) $1,732,984 
  Useful  Gross     Net 
  Life  December 31,  Accumulated  December 31, 
  (Years)  2017  Amortization  2017 
Indefinite Lived Assets:                
Medicare license  N/A  $1,994,000  $-  $1,994,000 
Amortized Intangible Assets:                
Network relationships  11-15   109,883,000   (35,842,508)  74,040,492 
Management contracts  15   22,832,000   (5,014,886)  17,817,114 
Member relationships  12   6,696,000   (46,500)  6,649,500 
Patient management platform  5   2,060,000   (34,336)  2,025,664 
Tradename/trademarks  20   1,011,000   (4,212)  1,006,788 
      $144,476,000  $(40,942,442) $103,533,558 

 

  Weighted  Gross     Net 
  Average  March 31,  Accumulated  March 31, 
  Life (Yrs.)  2017  Amortization  2017 
Indefinite Lived Assets:                
Medicare License  N/A  $704,000  $-  $704,000 
                 
Amortized Intangible Assets:                
Acquired Technology  5   1,312,500   (262,500)  1,050,000 
Network Relationships  5   220,000   (117,331)  102,669 
Trade Name  5   102,000   (54,400)  47,600 
      $2,338,500  $(434,231) $1,904,269 


TheIncluded in depreciation and amortization on the accompanying consolidated statements of income is amortization expense of $4,211,621 and $4,322,476 (excluding $106,000 amortization expense for exclusivity incentives) for the three months ended June 30, 2018 and 2017, respectively, and $8,606,522 and $8,697,317 (excluding $212,000 amortization expense for exclusivity incentives) for the six months ended SeptemberJune 30, 2018 and 2017, respectively.

Future amortization expense is estimated to be as follows for the years ending December 31:

  Amount 
    
2018 (remaining six months) $8,050,000 
2019  14,480,000 
2020  12,671,000 
2021  10,961,000 
2022  9,448,000 
Thereafter  37,323,000 
     
  $92,933,000 
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5.Investments in Other Entities

Equity Method Investments

LaSalle Medical Associates

LaSalle Medical Associates (“LMA”) was founded by Dr. Albert Arteaga in 1996 and 2016 was approximately $171,000currently operates four neighborhood medical centers employing more than 120 dedicated healthcare professionals, treating children, adults and $190,000, respectively. The amortizationseniors in San Bernardino County. LMA’s patients are primarily served by Medi-Cal. LMA accepts Blue Cross, Blue Shield, Molina, Care 1st, Health Net and Inland Empire Health Plan. LMA is also an IPA of independently contracted doctors, hospitals and clinics, delivering high quality care to more than 245,000 patients in Fresno, Kings, Los Angeles, Madera, Riverside, San Bernardino and Tulare Counties. During 2012, APC-LSMA and LMA entered into a share purchase agreement whereby APC-LSMA invested $5,000,000 for a 25% interest in LMA’s IPA line of business. NMM has a management services agreement with LMA. APC accounts for its investment in LMA under the equity method as APC has the ability to exercise significant influence, but not control over LMA’s operations. For the three months ended SeptemberJune 30, 2018 and 2017, APC recorded loss from this investment of $603,692 and 2016$798,185, respectively, in the accompanying consolidated statements of income. For the six months ended June 30, 2018 and 2017, APC recorded (loss) income from this investment of $(956,484) and $513,554, respectively, in the accompanying consolidated statements of income. The investment balance was approximately $82,000$8,496,283 and $95,000,$9,452,767 at June 30, 2018 and December 31, 2017, respectively.

 

LMA’s summarized balance sheets at June 30, 2018 and December 31, 2017 and summarized statements of income for the six months ended June 30, 2018 and 2017 with respect to its IPA line of business are as follows:

Balance Sheets

  June 30, 2018  December 31,
2017
 
       
Assets        
         
Cash and cash equivalents $21,943,637  $21,065,105 
Receivables, net  2,276,731   2,433,116 
Other current assets  2,173,110   1,565,606 
Loan receivable  1,250,000   1,250,000 
Restricted cash  664,612   662,109 
         
Total assets $28,308,090  $26,975,936 

Liabilities and Stockholders’ Equity

  June 30, 2018  December 31,
2017
 
       
Current liabilities $25,511,420  $20,353,337 
Stockholders’ equity  2,796,670   6,622,599 
         
Total liabilities and stockholders’ equity $28,308,090  $26,975,936 

Statements of Income

  

Six Months
Ended
June 30, 2018

  Six Months
Ended
June 30, 2017
 
       
Revenues $110,311,466  $97,902,002 
Expenses  113,744,898   95,847,786 
         
Net (loss) income $(3,433,432) $2,054,216 

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Pacific Medical Imaging and Oncology Center, Inc.

PMIOC was incorporated in 2004 in the state of California. PMIOC provides comprehensive diagnostic imaging services using state-of-the-art technology. PMIOC offers high quality diagnostic services such as MRI/MRA, PET/CT, CT, nuclear medicine, ultrasound, digital x-rays, bone densitometry and digital mammography at its facilities.

In July 2015, APC-LSMA and PMIOC entered into a share purchase agreement whereby APC-LSMA invested $1,200,000 for a 40% ownership in PMIOC.

APC and PMIOC have an Ancillary Service Contract together whereby PMIOC provides covered services on behalf of APC to enrollees of the plans of APC. Under the Ancillary Service Contract APC paid PMIOC fees for the three and six months ended June 30, 2018 and 2017 of approximately $0.8 million and $0.6 million, respectively, and of approximately $1.2 million and $1.1 million, respectively. APC accounts for its investment in PMIOC under the equity method of accounting as APC has the ability to exercise significant influence, but not control over PMIOC’s operations. During the three months ended June 30, 2018 and 2017, APC recorded income from this investment of $62,606 and $58,539 respectively, in the accompanying consolidated statements of income. During the six months ended June 30, 2018 and 2017, APC recorded income from this investment of $36,581 and $109,619, respectively, in the accompanying consolidated statements of income. The following table summarizesaccompanying balance sheet has an investment balance of $1,437,274 and $1,400,693 at June 30, 2018 and December 31, 2017, respectively.

Universal Care, Inc.

UCI is a privately held health plan that has been in operation since 1985 in order to help its members through the approximate expected future amortization expensecomplexities of the healthcare system. UCI holds a license under the California Knox-Keene Health Care Services Plan Act (“Knox-Keene Act”) to operate as a full-service health plan. UCI contracts with CMS under the Medicare Advantage Prescription Drug Program.

On August 10, 2015, UCAP, an entity solely owned 100% by APC with APC’s executives, Dr. Thomas Lam, Dr. Pen Lee and Dr. Kenneth Sim, as designated managers of UCAP, purchased from UCI 100,000 shares of UCI class A-2 voting common stock (comprising 48.9% of the total outstanding UCI shares, but 50% of UCI’s voting common stock) for $10,000,000. APC accounts for its investment in UCI under the equity method of accounting as APC has the ability to exercise significant influence, but not control over UCI’s operations. During the three months ended June 30, 2018 and 2017, the Company recorded income (loss) from this investment of $1,731,927 and $(280,710), respectively, in the accompanying consolidated statements of income. During the six months ended June 30, 2018 and 2017, the Company recorded income from this investment of $1,711,725 and $242,591, respectively, in the accompanying consolidated statements of income. The accompanying balance sheet has an investment balance of $10,321,180 and $8,609,455 at June 30, 2018 and December 31, 2017, respectively.

In 2015, APC advanced $5,000,000 on behalf of UCAP to UCI for working capital purposes. On June 29, 2018, APC advanced an additional $2,500,000. These subordinated loans accrue interest at the prime rate plus 1%, or 6.00% and 5.50% as of SeptemberJune 30, 2018 and December 31, 2017, respectively, with interest to be paid monthly. The repayment schedule of definite-lived intangible assets for eachthe original principal of $5,000,000 is based on certain contingent criteria, and accordingly, the entire note receivable has been classified under loans receivable - related parties on the consolidated balance sheets in the amount of $7,500,000 and $5,000,000 as of June 30, 2018 and December 31, 2017, respectively.

UCI’s balance sheets at June 30, 2018 and December 31, 2017 and statements of income for the four fiscal years ending March 31 thereafter:six months ended June 30, 2018 and 2017 are as follows:

 

2018 (remaining 6 months) $163,000 
2019  327,000 
2020  284,000 
2021  254,984 
  $1,028,984 

Balance Sheets

  

June 30, 2018

  December 31,
2017
 
       
Assets        
         
Cash $27,874,357  $21,872,894 
Receivables, net  29,042,535   18,618,760 
Other current assets  19,541,123   13,021,520 
Other assets  3,259,848   3,754,470 
Property and equipment, net  2,132,063   1,576,621 
         
Total assets $81,849,926  $58,844,265 

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Liabilities and Stockholders’ Deficit

  June 30, 2018  December 31,
2017
 
       
Current liabilities $68,941,956  $54,421,532 
Other liabilities  15,036,729   10,051,952 
Stockholders’ deficit  (2,128,759)  (5,629,219)
         
Total liabilities and stockholders’ deficit $81,849,926  $58,844,265 

Statements of Income Operations

  

Six Months
Ended

June 30, 2018

  Six Months
Ended
June 30, 2017
 
       
Revenues $149,825,595  $91,586,434 
Expenses  146,614,334   90,759,639 
         
Income before (benefit) provision for income taxes  3,211,261   826,795 
(Benefit) provision for income taxes  (289,200)  330,700 
         
Net income $3,500,461  $496,095 

Diagnostic Medical Group

On May 14, 2016, David C.P. Chen M.D., Inc., a California professional corporation doing business as Diagnostic Medical Group (“DMG”), and David C.P. Chen M.D., individually and APC-LSMA, a designated shareholder professional corporation formed on October 15, 2012, which is 100% owned by Dr. Thomas Lam (CEO of APC) and is controlled and consolidated by APC who is the primary beneficiary of this VIE, entered into a share purchase agreement whereby APC-LSMA acquired a 40% ownership interest in DMG for total cash consideration of $1,600,000.

APC accounts for its investment in DMG under the equity method of accounting as APC has the ability to exercise significant influence, but not control over DMG’s operations. For the three and six months ended June 30, 2018 and 2017, APC recorded income from this investment of $391,613 and $198,760 and $720,655 and $560,404, respectively, in the accompanying consolidated statements of income and has an investment balance of $2,568,066 and $1,847,411 at June 30, 2018 and December 31, 2017, respectively.

Pacific Ambulatory Surgery Center, LLC

PASC, a California limited liability company, is a multi-specialty outpatient surgery center that is certified to participate in the Medicare program and is accredited by the Accreditation Association for Ambulatory Health Care. PASC has entered into agreements with organizations such as healthcare service plans, independent physician practice associations, medical groups and other purchasers of healthcare services for the arrangement of the provision of outpatient surgery center services to subscribers or enrollees of such health plans. On November 15, 2016, PASC and APC, entered into a membership interest purchase agreement whereby PASC sold 40% of its aggregate issued and outstanding membership interests to APC for total consideration of $800,000.

In connection with the membership interest purchase agreement, PASC entered into a management services agreement with NMM, which requires the payment of management fees computed at predetermined percentage (as defined) of PASC revenues. The term of the management services agreement commenced on the effective date and extend for a period of 60 months thereafter, and may be extended in writing at the sole option of NMM for an additional period of 60 months following the expiration of the initial term and is automatically renewed for additional consecutive terms of three years unless terminated by either party. PASC shall not be permitted to terminate the management services agreement for any reason during the initial term and, if extended, the extended term.

APC accounts for its investment in PASC under the equity method of accounting as APC has the ability to exercise significant influence, but not control over PASC’s operations. For the three and six months ended June 30, 2018 and 2017, APC recorded income from this investment of $87,407 and $26,494 and $129,360 and $5,992, respectively, in the accompanying consolidated statements of income and has an investment balance of $722,558 and $593,198 at June 30, 2018 and December 31, 2017, respectively.

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Equity Method Investment Summary

Investments in other entities – equity method consisted of the following:

  June 30,
2018
  December 31,
2017
 
       
Universal Care, Inc. $10,321,180  $8,609,455 
LaSalle Medical Associates – IPA Line of Business  8,496,283   9,452,767 
Diagnostic Medical Group  2,568,066   1,847,411 
Pacific Medical Imaging & Oncology Center, Inc.  1,437,274   1,400,693 
Pacific Ambulatory Surgery Center, LLC  722,558   593,198 
         
  $23,545,361  $21,903,524 

Joint Venture

In June 2018, College Street Investment LP, a California limited partnership (“CSI”), APC and NMM entered into an operating agreement to govern the limited liability company, 531 W. College, LLC and the conduct of its business, and to specify their relative rights and obligations. CSI, APC and NMM, each owns 50%, 25% and 25%, respectively, of member units based on initial capital contributions of $16,673,839, $8,336,920, and $8,336,920, respectively.

An agreement of purchase and sale and joint escrow instructions (“Purchase Agreement”) with an effective date of April 10, 2018 was entered into between 531 W. College, LLC and Societe Francaise De Bienfaisance Mutuelle De Los Angeles, a California nonprofit corporation, pursuant to which 531 W. College LLC agreed to purchase a former hospital located in the City of Los Angeles. The total purchase price of such real estate is $33,347,679. In June 2018, APC, NMM and AMHC Healthcare, Inc. on behalf of CSI, wired $8,336,920, $8,336,920 and $16,673,839, respectively into an escrow account for the benefit of 531 W. College, LLC to purchase the hospital pursuant to the Purchase Agreement. The transaction closed on June 29, 2018. APC and NMM accounts for its investment in 531 W. College, LLC under the equity method of accounting as APC and NMM have the ability to exercise significant influence, but not control over the operations of this joint venture. APC and NMM’s investment is presented as an investment in joint venture-equity method in the accompanying condensed consolidated balance sheet as of June 30, 2018.

531 W. College LLC’s balance sheet at June 30, 2018 is as follows:

Balance Sheet

  June 30, 2018 
    
Assets    
     
Land and Building $33,347,679 
     
Total assets $33,347,679 
     
Liabilities and Members’ Equity    
     
Members’ equity $33,347,679 
     
Total liabilities and members’ equity $33,347,679 

Formation costs and other fees incurred for establishing the organization were not significant during the six months ended June 30, 2018. 

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Investment in privately held entity that does not report net asset value per share

In May 2018, APC purchased 270,000 membership interests of MediPortal LLC, a New York limited liability company, for $405,000 or $1.50 per membership interest, which represented approximately 2.8% ownership. APC also received a 5-year warrant to purchase 270,000 membership interests. A 5-year option to purchase an additional 380,000 membership interests and a 5-year warrant to purchase 480,000 membership interests are contingent upon the portal completion date, which has not be completed as of June 30, 2018. As APC does not have the ability to exercise significant influence, and lacks control, over the investee, this investment is accounted for using a measurement alternative which allows the investment to be measured at cost, adjusted for observable price changes and impairments, with changes recognized in net income.

 

4.6.Loan Receivable

On October 9, 2017, NMM and APC-LSMA entered into an agreement with Accountable Health Care IPA (“Accountable”), a California professional medical corporation, Signal Health Solutions, Inc. (“Signal”), a California corporation and George M. Jayatilaka, M.D. (“Dr. Jay”), individually, whereby concurrent with the execution of the agreement, APC-LSMA extended a line of credit to Dr. Jay in the principal amount of $10,000,000 (“Dr. Jay Loan”) to fund the working capital needs of Accountable ($5,000,000 of which was funded by APC on behalf of APC-LSMA and the other $5,000,000 was funded by NMM to Dr. Jay). Interest on the Dr. Jay Loan accrues at a rate that is equal to the prime rate plus 1% (6.00% and 5.50% as of June 30, 2018 and December 31, 2017, respectively) and payable in monthly installments of interest only on the first day of each month until the date that is three years following the initial date of funding, at which time, all outstanding principal and accrued interest thereon shall be due and payable in full. The Dr. Jay Loan is not subordinated to any other indebtedness and is secured by a first-lien security interest in certain shares of Accountable owned by Dr. Jay. The outstanding balance as of both June 30, 2018 and December 31, 2017 was $10,000,000.

Concurrently with the funding of the Dr. Jay Loan, Dr. Jay loaned to Accountable the entire proceeds of the Dr. Jay Loan at the same interest rate and maturity date as the Dr. Jay Loan (“Dr. Jay-Accountable Subordinated Loan”). Repayment of the Dr. Jay-Accountable Subordinated Loan is subordinated to Accountable’s creditors in a manner acceptable to the California Department of Managed Health Care (“DMHC”).

At any time on or before the date that is one year following the initial funding date of the Dr. Jay Loan, APC-LSMA or its designee have the right, but not the obligation, to convert up to $5,000,000 of the outstanding principal amount into shares of Accountable’s capital stock. At any time after the date that is one year following the funding date, the Dr. Jay Loan may be prepaid at any time. Within three years following the initial funding of the Dr. Jay Loan, APC-LSMA or its designee shall have the right, but not the obligation, to convert the then outstanding principal amount into Accountable shares based on Accountable’s then-current valuation.

Subsequent to the funding of the Dr. Jay Loan, to the extent needed by Accountable for working capital needs as determined by APC-LSMA, APC-LSMA will extend an additional line of credit in the principal amount up to $8,000,000. The funding mechanism, interest rate and maturity date of such additional line of credit shall be the same as the Dr. Jay Loan and additional collateral security in Accountable’s issued and outstanding shares will be required.

As a condition of funding the Dr. Jay Loan, Accountable entered into a ten-year management service agreement with NMM on October 27, 2017, to commence on the termination of Accountable’s previously existing management agreement with MedPoint Management to be effective on December 1, 2017. Under the management service agreement, NMM is responsible for managing 100% of all health plan membership assigned and delegated to Accountable, and all hospital risk pools. The management service agreement requires the payment of IPA and hospital risk pool management fees as set forth therein.

Concurrent with the initial funding of the Dr. Jay Loan, the Accountable Board of Directors shall be automatically reconstituted to be comprised of two directors, which will comprise of Dr. Jay and a director appointed by APC-LSMA. Dr. Jay and APC-LSMA will have two and one votes as a director, respectively.

Based on management’s assessment, Accountable is a variable interest entity. However, the Company does not have the power to the direct the activities of Accountable that most significantly impact its economic performance and as such, the Company is not the primary beneficiary of Accountable.

7.Accounts Payable and Accrued Expenses

The Company’s accounts payable and accrued expenses consisted of the following:

  June 30,
2018
  December 31,
2017
 
       
Accounts payable $3,632,691  $3,786,381 
Specialty capitation payable  300,000   547,307 
Subcontractor IPA risk pool payable  1,660,366   1,348,376 
Professional fees  3,488,386   3,004,215 
Deferred revenue  708,591   250,000 
Accrued compensation  2,797,859   4,343,341 
         
  $12,587,893  $13,279,620 

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8.Medical Liabilities

 

Accounts payable and accruedThe Company’s medical liabilities consisted of the following:

 

  September 30,  March 31, 
  2017  2017 
Accounts payable $2,165,151  $3,569,011 
Accrued compensation  3,649,166   2,860,340 
Income taxes payable  391   20,827 
Accrued interest  338,604   54,158 
Accrued professional fees  888,731   1,379,037 
  $7,042,043  $7,883,373 

  June 30, 2018  December 31, 2017 
       
Balance, beginning of period $63,972,318  $18,957,465 
Medical liabilities assumed from Merger  -   39,353,540 
Claims paid for previous period  (34,591,915)  (23,075,516)
Incurred health care costs  104,977,066   121,846,375 
Claims paid for current period  (66,848,868)  (92,476,160)
Adjustments  (655,266  (633,386)
         
Balance, end of period $66,853,335  $63,972,318 

 

9.Bank Loan, Lines of Credit and Loan Payable – Related Party

Bank Loans

In December 2010, ICC borrowed a $4,600,000 loan from a financial institution. The loan bears interest based on the Wall Street Journal “prime rate”, or 5.00% and 4.50% per annum, as of June 30, 2018 and December 31, 2017, respectively. The loan is collateralized by the medical equipment ICC owns and guaranteed by one of ICC’s shareholders. The loan matures on December 31, 2018. As of June 30, 2018 and December 31, 2017, the balance outstanding was $278,017 and $510,391, respectively, and is classified as current liabilities. As of June 30, 2018, and December 31, 2017, ICC was in compliance with all affirmative and negative covenants contained in the loan agreement.

Lines of Credit

On June 14, 2018, NMM amended its promissory note agreement with a bank (“NMM Business Loan Agreement”), which provides for loan availability of up to $20,000,000 with a maturity date of June 22, 2020. The interest rate is based on the Wall Street Journal “prime rate” plus 0.125%, or 5.125% and 4.625%, as of June 30, 2018 and December 31, 2017, respectively. As of December 31, 2017, NMM was not in compliance with certain financial debt covenant requirements contained in the loan agreement for which NMM obtained a waiver through June 30, 2018. As of June 30, 2018, NMM was in compliance with such financial debt covenant requirements. Pursuant to the June 2018 amendment, certain covenants were modified or deleted in its entirety; the loan is guaranteed by Apollo Medical Holdings, Inc. and is collateralized by substantially all assets of NMM. In October 2017, NMM borrowed $5,000,000 on this line of credit to make a $5,000,000 loan advance to Accountable Health Care IPA (see Note 6), and on June 27, 2018, NMM borrowed an additional $8,000,000 under this line of credit to fund its investment in 531 W. College LLC. The amount outstanding as of June 30, 2018 and December 31, 2017 was $13,000,000 and $5,000,000, respectively. As of June 30, 2018 and December 31, 2017, availability under this line of credit was $300,671 and $8,300,671, respectively.

On June 14, 2018, APC amended its promissory note agreement with a bank (“APC Business Loan Agreement”), which provides for loan availability of up to $10,000,000 with a maturity date of June 22, 2020. The interest rate is based on the Wall Street Journal “prime rate” plus 0.125%, or 5.125% and 4.625%, as of June 30, 2018 and December 31, 2017, respectively. As of December 31, 2017, APC was not in compliance with certain financial debt covenant requirements contained in the loan agreement for which APC obtained a waiver through June 30, 2018. As of June 30, 2018, APC was in compliance with such financial debt covenant requirements. Pursuant to the June 2018 amendment, certain covenants were modified or deleted in its entirety and the guarantee made by individual shareholders of APC was removed. The loan is also collateralized by substantially all assets of APC. No amounts were drawn on this line during the six months ended June 30, 2018 and no amounts were outstanding as of June 30, 2018 and December 31, 2017. As of both June 30, 2018 and December 31, 2017, availability under this line of credit was $9,694,984.

Standby Letters of Credit

On March 3, 2017, APAACO established an irrevocable standby letter of credit with a financial institution (through the NMM Business Loan Agreement) for $6,699,329 for the benefit of CMS. The letter of credit expires on December 31, 2018 and deemed automatically extended without amendment for additional one - year periods from the present or any future expiration date, unless notified by the institution to terminate prior to 90 days from any expiration date. APAACO may continue to draw from the letter of credit for one year following the bank’s notification of non-renewal.

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APC established irrevocable standby letters of credit with a financial institution for a total of $305,016 for the benefit of certain health plans. The standby letters of credit are automatically extended without amendment for additional one-year periods from the present or any future expiration date, unless notified by the institution in advance of the expiration date that the letter will be terminated.

10.Mezzanine and Stockholders’ Equity

All the historical NMM share and per share information has been adjusted to reflect the exchange ratio from the Merger (see Note 3).

Mezzanine

APC

As the redemption feature (see Note 2) of the shares is not solely within the control of APC, the equity of APC does not qualify as permanent equity and has been classified as noncontrolling interests in mezzanine or temporary equity.

Stockholders’ Equity

As of the date of this Quarterly Report on Form 10-Q, 751,067 holdback shares have not been issued to certain former NMM shareholders who were NMM shareholders at the time of Closing of the Merger, as they have yet to submit properly completed letters of transmittal to ApolloMed in order to receive their pro rata portion of ApolloMed common stock and warrants as contemplated under the Merger Agreement. Pending such receipt, such former NMM shareholders have the right to receive, without interest, their pro rata share of dividends or distributions with a record date after the effectiveness of the Merger. The condensed consolidated financial statements have treated such shares of common stock as outstanding, given the receipt of the letter of transmittal is considered perfunctory and the Company is legally obligated to issue these shares in connection with the Merger.

On March 21, 2018, the Company issued 37,593 shares of the Company’s common stock to the Company’s Chief Operating Officer for prior services rendered. The stock price on the date of issuance was $16.80, which resulted in the Company recording $631,562 of share-based compensation expense.

See options and warrants section below for common stock issued upon exercise of stock options and stock purchase warrants.

Options

The Company’s outstanding stock options consisted of the following:

  Shares  Weighted
Average
Exercise Price
  Weighted
Average
Remaining
Contractual
Term
(Years)
  Aggregate
Intrinsic
Value
 
             
Options outstanding at January 1, 2018  1,141,040  $3.95   5.79  $19.81 
Options granted  155,000   9.85   -   - 
Options exercised  (301,036)  3.87   -   16.63 
Options forfeited  (4,000)  5.79   -   - 
                 
Options outstanding at June 30, 2018  991,004  $5.16   4.92  $20.70 
                 
Options exercisable at June 30, 2018  991,004  $5.16   4.92  $20.70 

During the six months ended June 30, 2018, stock options were exercised pursuant to the cashless exercise provision of the option agreement, with respect to 60,536 shares of the Company’s common stock, which resulted in the Company issuing 47,576 net shares.

During the six months June 30, 2018, stock options were exercised for 240,500 shares of the Company’s common stock, which resulted in proceeds of approximately $817,000. The exercise price ranged from $0.01 to $10.00 per share.

Outstanding stock options granted to primary care physicians to purchase shares of APC’s common stock consisted of the following:

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  Shares  Weighted
Average
Exercise Price
  Weighted
Average
Remaining
Contractual
Term
(Years)
  Aggregate
Intrinsic
Value
 
             
Options outstanding at January 1, 2018  853,800  $0.167   1.75  $508,864 
Options granted  -   -   -   - 
Options exercised  -   -   -   - 
Options expired/forfeited  -   -   -   - 
                 
Options outstanding at June 30, 2018  853,800  $0.167   1.25  $508,864 
                 
Options exercisable at June 30, 2018  853,800  $0.167   1.25  $508,864 

The aggregate intrinsic value is calculated as the difference between the exercise price and the estimated fair value of common stock as of June 30, 2018.

Share-based compensation expense related to option awards granted to primary care physicians to purchase shares of APC’s common stock, are recognized over their respective vesting periods, and consisted of the following:

  Three Months Ended
June 30,
  Six Months Ended
June 30,
 
  2018  2017  2018  2017 
Share-based compensation expense:                
Cost of services $-  $1,227  $-  $2,454 
General and administrative  202,382   320,006   404,764   640,012 
  $202,382  $321,233  $404,764  $642,466 

The remaining unrecognized share-based compensation expense of stock option awards granted to primary care physicians to purchase shares of APC’s common stock as of June 30, 2018 was $1,011,910, which is expected to be recognized over the remaining term of 1.25 years.

Warrants

The Company’s outstanding warrants consisted of the following:

  Shares  Weighted
Average
Exercise Price
  Weighted
Average
Remaining
Contractual
Term
(Years)
  Aggregate
Intrinsic
Value
 
             
Warrants outstanding at January 1, 2018  3,648,541  $9.75   3.74  $14.25 
Warrants granted  -   -   -   - 
Warrants exercised  (210,625)  7.27   -   10.46 
Warrants expired/forfeited  (11,250)  -   -   - 
                 
Warrants outstanding at June 30, 2018  3,426,666  $9.91   3.46  $15.95 

            Weighted 
      Weighted     Average 
      Average     Exercise Price 
Exercise Price Per  Warrants  Remaining  Warrants  Per 
Share  Outstanding  Contractual Life  Exercisable  Share 
              
$4.50   5,000   0.35   5,000  $4.50 
 9.00   1,116,111   2.28   1,116,111   9.00 
 10.00   1,455,555   3.80   1,455,555   10.00 
 11.00   850,000   4.44   850,000   11.00 
                   
$4.50 –11.00   3,426,666   3.46   3,426,666  $9.91 

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During the six months ended June 30, 2018, common stock warrants were exercised for 210,625 shares of the Company’s common stock, which resulted in proceeds of approximately $1.5 million. The exercise price ranged from $4.00 to $10.00 per share.

Treasury Stock 

APC owns 1,682,110 shares of ApolloMed’s common stock as of June 30, 2018 and December 31, 2017, which are legally issued and outstanding but excluded from shares of common stock outstanding in the condensed consolidated financial statements, as such shares are treated as treasury shares for accounting purposes.

Dividends

During the first quarter of 2018, APC distributed $2,000,000 of dividends to APC shareholders.

In April 2018, NMM distributed approximately $10,000,000 to former NMM shareholders, from the $18,000,000 that was previously classified as restricted cash and dividends payable. As of June 30, 2018, $8,000,000 of restricted cash remains from the Merger, and are still held for distribution.

11.Commitments and Contingencies

Regulatory Matters

Laws and regulations governing the Medicare program and healthcare generally are complex and subject to interpretation. The Company believes that it is in compliance with all applicable laws and regulations and is not aware of any pending or threatened investigations involving allegations of potential wrongdoing. While no regulatory inquiries have been made, compliance with such laws and regulations can be subject to future government review and interpretation as well as significant regulatory action including fines, penalties, and exclusion from the Medicare and Medi-Cal programs.

As risk-bearing organizations, APC and MMG are required to follow regulations of the DMHC, including maintenance of minimum working capital, tangible net equity (“TNE”), cash-to-claims ratio and claims payment requirements prescribed by the DMHC. TNE is defined as net equity less intangibles, less non-allowable assets (which include unsecured amounts due from affiliates), plus subordinated obligations. At June 30, 2018 and December 31, 2017, APC was in compliance with these regulations. At December 31, 2017, MMG was not in compliance with these regulations. As a result, the California DMHC required MMG to develop and implement a corrective action plan (“CAP”) for such deficiency. MMG received confirmation from substantially all of MMG’s direct-contracted health plans, that they have moved membership out of MMG effective May 1, 2018, and as a result, as of June 30, 2018, MMG was no longer required to be in compliance with these regulations.

Many of the Company’s payor and provider contracts are complex in nature and may be subject to differing interpretations regarding amounts due for the provision of medical services. Such differing interpretations may not come to light until a substantial period of time has passed following contract implementation. Liabilities for claims disputes are recorded when the loss is probable and can be estimated. Any adjustments to reserves are reflected in current operations.

Litigation

From time to time, the Company is involved in various legal proceedings and other matters arising in the normal course of its business. The resolution of any claim or litigation is subject to inherent uncertainty and could have a material adverse effect on the Company’s financial condition, cash flows or results of operations.

On or about March 23, 2018 and April 3, 2018, a Demand for Arbitration and an Amended Demand for Arbitration were filed by Prospect Medical Group, Inc. and Prospect Medical Systems, Inc. (collectively, “Prospect”) against MMG, ApolloMed and AMM with Judicial Arbitration Mediation Services in California, arising out of MMG’s purported business plans, seeking damages in excess of $5 million, and alleging breach of contract, violation of unfair competition laws, and tortious interference with Prospect’s current and future economic relationships with its health plans and their members. MMG, ApolloMed and AMM dispute the allegations and intend to vigorously defend against this matter.

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12.Related Party Transactions

On November 16, 2015, UCAP entered into a subordinated note receivable agreement with UCI, a 48.9% owned equity method investee (see Note 5), in the amount of $5,000,000. On June 28, 2018, UCAP entered into a new subordinated note receivable agreement with UCI in the amount of $2,500,000.

During the three and six months ended June 30, 2018 and 2017, APC paid approximately $146,301 and $62,000, respectively, and $168,270 and $96,000, respectively, to Advanced Diagnostic Surgery Center for services as a provider. Advanced Diagnostic Surgery Center shares common ownership with certain board members of APC.

During the three and six months ended June 30, 2018 and 2017, NMM received approximately $5.2 million and $4.4 million, respectively, and $9.9 million and $8.9 million, respectively, in management fees from LMA, which is accounted for under the equity method based on 25% equity ownership interest held by APC in LMA’s IPA line of business (see Note 5).

During the three and six months ended June 30, 2018 and 2017, APC paid approximately $0.8 million and $0.6 million, respectively, and $1.2 million and $1.1 million, respectively, to PMIOC for provider services, which is accounted for under the equity method based on 40% equity ownership interest held by APC (see Note 5).

During the three and six months ended June 30, 2018 and 2017, APC paid approximately $1.2 million and $0.5 million, respectively, and $1.9 million and $1.3 million, respectively, to AMG, Inc. for services as a provider. AMG, Inc. shares common ownership with certain board members of APC.

In September 2015, ApolloMed entered into a note receivable with Rob Mikitarian, a minority owner in APS, in the amount of approximately $150,000. The note accrues interest at 3% per annum and currently due on demand. As of June 30, 2018, and December 31, 2017, the balance of the note was approximately $150,000 and is included in other receivables in the accompanying consolidated balance sheets.

In addition, affiliates wholly-owned by the Company’s officers, including Dr. Lam and Dr. Hosseinion, are reported in the accompanying consolidated statement of income on a consolidated basis, together with the Company’s subsidiaries, and therefore, the Company does not separately disclose transactions between such affiliates and the Company’s subsidiaries as related party transactions.

During the three and six months ended June 30, 2018 and 2017, APC paid approximately $2.1 million and $1.6 million, respectively, and $3.7 million and $3.0 million, respectively, to DMG for provider services, which is accounted for under the equity method based on 40% equity ownership interest held by APC (see Note 5).

During the three and six months ended June 30, 2018 and 2017, NMM paid approximately $0.3 million and $0.3 million, respectively, and $0.5 million and $0.6 million, respectively, to Medical Property Partners (“MPP”) for an office lease. MPP shares common ownership with certain board members of NMM.

During the three and six months ended June 30, 2018 and 2017, APC paid $90,000 and $90,000, respectively, and $180,000 and $180,000, respectively, to Tag-2 Medical Investment Group, LLC (“Tag-2”) for an office lease. Tag-2 shares common ownership with certain board members of APC.

During the three and six months ended June 30, 2018 and 2017, APC paid an aggregate of approximately $11.6 million and $10.1 million, respectively, and $20.8 million and $22.9 million, respectively, to shareholders of APC for provider services, which include approximately $3.9 million and $3.9 million, respectively, and $6.1 million and $9.3 million, respectively, to shareholders who are also officers of APC.

For loans receivable from related parties, see Note 5.

13.Revenue Recognition

At the adoption of Topic 606, the cumulative effect of initially applying the new revenue standard is required to be presented as an adjustment to the opening balance of retained earnings. This cumulative effect amount was determined to be related to the full risk pool arrangements of APC, a variable interest entity (see Note 1). Therefore, the cumulative net effect of initially applying Topic 606 in the amount of $10,208,000, which is comprised of $11,600,000 of additional revenue, offset by $1,392,000 in related management fee expense, has been presented as an adjustment to the opening balance of the mezzanine equity, “Noncontrolling interest in Allied Pacific of California IPA.” Consequently, as a result of APC recording additional receivables, NMM recorded a corresponding entry of $1,392,000 to retained earnings to record the related management fee income. These adjustments were offset by an aggregate adjustment to deferred tax liability of $3,246,098.

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The impact of the adoption of this ASU on the Company’s revenue, when comparing the amount of revenue recognized for the three and six months ended June 30, 2018 to the revenue that would have been recognized under the prior revenue standard ASC 605, are summarized as follows:

The table below presents the impact of the adoption of ASC 606 on the Company’s consolidated statements of income.

  Three months ended June 30, 2018 
  Under ASC  Effect of ASC  As Reported 
  605  606  Under ASC 606 
Risk pool settlements and incentives $10,466,217  $3,400,000  $13,866,217 
Total revenue  119,604,546   3,400,000   123,004,546 
Provision for income taxes  572,364   951,443   1,523,807 
Net income  5,417,036   2,448,557   7,865,593 
Net income attributable to noncontrolling interest  3,046,761   2,154,730   5,201,491 
Net income attributable to Apollo Medical Holdings, Inc. $2,370,275  $293,827  $2,664,102 
             
Earnings per share - basic $0.07  $0.01  $0.08 
Earnings per share - diluted $0.06  $0.01  $0.07 

  Six months ended June 30, 2018 
  Under ASC  Effect of ASC  As Reported 
  605  606  Under ASC 606 
Risk pool settlements and incentives $28,452,953  $3,400,000  $31,852,953 
Total revenue  243,771,273   3,400,000   247,171,273 
Provision for income taxes  7,801,204   951,443   8,752,647 
Net income  21,134,691   2,448,557   23,583,248 
Net income attributable to noncontrolling interest  16,603,961   2,154,730   18,758,691 
Net income attributable to Apollo Medical Holdings, Inc. $4,530,730  $293,827  $4,824,557 
             
Earnings per share - basic $0.14  $0.01  $0.15 
Earnings per share - diluted $0.12  $0.01  $0.13 

The table below presents the impact of the adoption of ASC 606 on the Company’s consolidated balance sheet.

  June 30, 2018 
  Under ASC  Effect of ASC  As Reported 
  605  606  Under ASC 606 
Assets            
Trade accounts receivable, net $31,141,815  $3,400,000  $34,541,815 
Total assets  507,577,108   3,400,000   510,977,108 
Noncurrent liabilities            
Deferred tax liability  26,807,337   951,443   27,758,780 
Mezzanine equity            
Noncontrolling interest in Alliled Pacific of California IPA  193,759,589   2,154,730   195,914,319 
Shareholders’ equity            
Retained earnings  7,267,729   293,827   7,561,556 
Total liabilities, mezzanine equity and stockholders' equity $166,221,944  $3,400,000  $169,621,944 

The cumulative effect of changes made to the Company’s condensed consolidated balance sheet as of January 1, 2018 for the adoption of Topic 606 were as follows:

  Balance at
December 31,
2017
  Adjustments
due to Topic
606
  Balance at
January 1, 2018
 
Current Assets            
Receivables $20,117,304  $11,600,000  $31,717,304 
             
Liabilities, Mezzanine Equity and Stockholders’ Equity            
             
Noncurrent Liabilities            
Deferred tax liability $24,916,598  $3,246,098  $28,162,696 
             
Mezzanine equity            
Noncontrolling interest in Allied Pacific of California IPA $172,129,744  $7,351,434  $179,481,178 
             
Stockholders’ Equity            
Retained earnings $1,734,531  $1,002,468  $2,736,999 

The Company operates as one reportable segment, the healthcare delivery segment. The Company disaggregates revenue from contracts by service type and by payor. This level of detail provides useful information pertaining to how the Company generates revenue by significant revenue stream and by type of direct contracts. The condensed consolidated statements of income present disaggregated revenue by service type. The following table presents disaggregated revenue generated by each payor type for the three and six months ended June 30, 2018 and 2017:

Three Months Ended June 30, 2018  June 30, 2017 
       
Commercial $97,852,959  $79,277,193 
Medicare  24,920,063   1,979,486 
Medicaid  183,794   - 
Other third parties  47,730   55,021 
Revenue $123,004,546  $81,311,700 

Six Months Ended June 30, 2018  June 30, 2017 
       
Commercial $203,231,219  $163,126,111 
Medicare  43,461,178   3,433,189 
Medicaid  360,144   - 
Other third parties  118,732   88,462 
Revenue $247,171,273  $166,647,762 

The Company receives payments from the following sources for services rendered: (i) commercial insurers; (ii) the federal government under the Medicare program administered by CMS; (iii) state governments under the Medicaid and other programs; (iv) other third party payors (e.g., hospitals); and (v) individual patients and clients. As the period between the time of service and time of payment is typically one year or less, the Company elected the practical expedient under ASC 606-10-32-18 and did not adjust for the effects of a significant financing component.

The Company derives a significant portion of its revenue from Medicare, Medicaid and other payors that receive discounts from established billing rates. The Medicare and Medicaid regulations and various managed care contracts under which these discounts must be calculated are complex, subject to interpretation and adjustment, and may include multiple reimbursement mechanisms for different types of services provided and cost settlement provisions. Management estimates the transaction price on a payor-specific basis given its interpretation of the applicable regulations or contract terms. The services authorized and provided and related reimbursements are often subject to interpretation that could result in payments that differ from the Company’s estimates. Additionally, updated regulations and contract renegotiations occur frequently, necessitating regular review and assessment of the estimation process by management.

Settlements under cost reimbursement agreements with third-party payors are estimated and recorded in the period in which the related services are rendered and are adjusted in future periods as final settlements are determined. Final determination of amounts earned under the Medicare and Medicaid programs often occurs in subsequent years because of audits by such programs, rights of appeal and the application of numerous technical provisions.

Under the new revenue standard, the Company has elected to apply the following practical expedients and optional exemptions:

·Recognize incremental costs of obtaining a contract with amortization periods of one year or less as expense when incurred. These costs are recorded within general and administrative expenses.

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·Recognize revenue in the amount of consideration to which the Company has a right to invoice the customer if that amount corresponds directly with the value to the customer of the Company’s services completed to date.

·Exemptions from disclosing the value of unsatisfied performance obligations for (i) contracts with an original expected length of one year or less, (ii) contracts for which revenue is recognized in the amount of consideration to which the Company has a right to invoice for services performed, and (iii) contracts for which variable consideration is allocated entirely to a wholly unsatisfied performance obligation or to a wholly unsatisfied promise to transfer a distinct service that forms part of a single performance obligation.

·Use a portfolio approach for the fee-for-service (FFS) revenue stream to group contracts with similar characteristics and analyze historical cash collections trends.

·No adjustment is made for the effects of a significant financing component as the period between the time of service and time of payment is typically one year or less.

Nature of Services and Revenue Streams

Revenue primarily consists of capitation revenue, risk pool settlements and incentives, NGACO All-Inclusive Population-Based Payments (“AIPBP”) revenue, management fee income, MSSP surplus revenue and FFS revenue. Revenue is recorded in the period in which services are rendered. The form of billing and related risk of collection for such services may vary by type of revenue and the customer. The following is a summary of the principal forms of the Company’s billing arrangements and how revenue is recognized for each.

Capitation, net

Managed care revenues of the Company consist primarily of capitated fees for medical services provided by the Company under either provider service agreements (each, a “PSA”) or capitated arrangements directly made with various managed care providers including HMOs. Capitation revenue under the PSAs and HMO contracts is prepaid monthly to the Company based on the number of enrollees selecting the Company as their healthcare provider. Capitation revenue is recognized in the month in which the Company is obligated to provide services. Minor ongoing adjustments to prior months’ capitation, primarily arising from contracted HMOs finalizing their monthly patient eligibility data for additions or subtractions of enrollees, are recognized in the month they are communicated to the Company. Additionally, Medicare pays capitation using a “Risk Adjustment model,” which compensates managed care organizations and providers based on the health status (acuity) of each individual enrollee. Health plans and providers with higher acuity enrollees will receive more and those with lower acuity enrollees will receive less. Under Risk Adjustment, capitation is determined based on health severity, measured using patient encounter data. Capitation is paid on a monthly basis based on data submitted for the enrollee for the preceding year and is adjusted in subsequent periods after the final data is compiled. Positive or negative capitation adjustments are made for Medicare enrollees with conditions requiring more or less healthcare services than assumed in the interim payments. Since the Company cannot reliably predict these adjustments, periodic changes in capitation amounts earned as a result of Risk Adjustment are recognized when those changes are communicated by the health plans to the Company.

Per member per month (PMPM) managed care contracts generally have a term of one year or longer. All managed care contracts have a single performance obligation that constitutes a series for the provision of managed healthcare services for a population of enrolled members for the duration of the contract. The transaction price for PMPM contracts is variable as it primarily includes per member per month fees associated with unspecified membership that fluctuates throughout the contract. In certain contracts, PMPM fees also include adjustments for items such as performance incentives, performance guarantees and risk shares. The Company generally estimates the transaction price using the most likely methodology and amounts are only included in the net transaction price to the extent that it is probable that a significant reversal of cumulative revenue will not occur once any uncertainty is resolved. The majority of the Company’s net PMPM transaction price relates specifically to its efforts to transfer the service for a distinct increment of the series (e.g. day or month) and is recognized as revenue in the month in which members are entitled to service.

Risk Pool Settlements and Incentives

APC enter into full risk capitation arrangements with certain health plans and local hospitals, which are administered by a third party, where the hospital is responsible for providing, arranging and paying for institutional risk and APC is responsible for providing, arranging and paying for professional risk. Under a full risk pool sharing agreement, APC generally receives a percentage of the net surplus from the affiliated hospital’s risk pools with HMOs after deductions for the affiliated hospitals costs. Advance settlement payments are typically made quarterly in arrears if there is a surplus. Risk pool settlements under arrangements with health plans and hospitals are recognized using the most likely methodology and amounts are only included in revenue to the extent that it is probable that a significant reversal of cumulative revenue will not occur once any uncertainty is resolved. The assumptions for IBNR completion factor and constraint percentages were used by management in applying the most likely method.

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Under capitated arrangements with certain HMOs and APC participates in one or more shared risk arrangements relating to the provision of institutional services to enrollees (shared risk arrangements) and thus can earn additional revenue or incur losses based upon the enrollee utilization of institutional services. Shared risk capitation arrangements are entered into with certain health plans, which are administered by the health plan, where APC is responsible for rendering professional services, but the health plan does not enter into a capitation arrangement with a hospital and therefore the health plan retains the institutional risk. Shared risk deficits, if any, are not payable until and unless (and only to the extent of any) risk sharing surpluses are generated. At the termination of the HMO contract, any accumulated deficit will be extinguished. Risk pool settlements under arrangements with HMOs are recognized using the most likely methodology and amounts are only included in revenue to the extent that it is probable that a significant reversal of cumulative revenue will not occur once any uncertainty is resolved. Risk pools for the prior contract years are generally final settled in the third or fourth quarter of the following year.

As APAACO does not have sufficient insight into the financial performance of the shared risk pool with CMS because of unknown factors related to IBNR, risk adjustment factors, stop loss provisions, etc., an estimate cannot be developed. Due to these limitations, APAACO cannot determine the amount of surplus or deficit that will probably not be reversed in the future and therefore this shared risk pool revenue is considered to be fully constrained.

In addition to risk-sharing revenues, the Company also receives incentives under “pay-for-performance” programs for quality medical care, based on various criteria. As an incentive to control enrollee utilization and to promote quality care, certain HMOs have designed the quality incentive programs and commercial generic pharmacy incentive programs to compensate the Company for efforts it takes to improve the quality of services and for efficient and effective use of pharmacy supplemental benefits provided to the HMO’s members. The incentive programs track specific performance measures and calculate payments to the Company based on the performance measures. Incentives under “pay-for-performance” programs are recognized using the most likely methodology. As the Company does not have sufficient insight from the health plans on the amount and timing of the incentive payments, this revenue is considered to be fully constrained and is only recorded when such payments are received.

Generally for the foregoing arrangements, the final settlement is dependent on each distinct day’s performance within the annual measurement period but cannot be allocated to specific days until the full measurement period has occurred and performance can be assessed. As such, this is a form of variable consideration estimated at contract inception and updated through the measurement period (i.e. the contract year), to the extent the risk of reversal does not exist and the consideration is not constrained.

NGACO AIPBP Revenue

Under the NGACO Model, CMS grants the Company a pool of patients to manage (direct care and pay providers) based on a budget established with CMS. The Company is responsible for managing medical costs for these patients. The patients will receive services from physicians and other medical service providers that are both in-network and out-of-network. The Company receives capitation from CMS on a monthly basis to pay claims from in-network providers. The Company records such capitation received from CMS as revenue as the Company is primarily responsible and liable for managing the patient care and for satisfying provider obligations, is assuming the credit risk for the services provided by in-network providers through its arrangement with CMS, and has control of the funds, the services provided and the process by which the providers are ultimately paid. Claims from out-of-network providers are processed or paid by CMS and the Company’s profits or losses in managing the services provided by out-of-network providers are generally determined on an annual basis after reconciliation with CMS. Pursuant to the Company’s risk share agreement with CMS, the Company will be eligible to receive the surplus or be liable for the deficit according to the budget established by CMS based on the Company’s efficiency or lack thereof, respectively, in managing how the patients assigned to the Company by CMS are served by in-network and out-of-network providers. The Company’s profits or losses on providing such services are both capped by CMS, and are subject to significant estimation risk, whereby payments can vary significantly depending upon certain patient characteristics and other variable factors. Accordingly, the Company recognizes such surplus or deficit upon substantial completion of reconciliation and determination of the amounts. In accordance with the guidance in ASC 606-10-55-36 through 55-40 on principal versus agent considerations, the Company records such revenues in the gross amount of consideration.

The Company also has arrangements for billing and payment services with the medical providers within the NGACO network. The Company retains certain defined percentages of the payments made to the providers in exchange for using the Company’s billing and payment services. The revenue for this service is earned as payments are made to medical providers.

APAACO and CMS entered into a Next Generation ACO Model Participation Agreement (the “Participation Agreement”) with a term of two performance years through December 31, 2018. CMS may offer to renew the Participation Agreement for additional terms of two performance years.

For each performance year, the Company shall submit to CMS its selections for risk arrangement; the amount of the profit/loss cap; alternative payment mechanism; benefits enhancements, if any; and its decision regarding voluntary alignment under the NGACO Model. The Company must obtain CMS consent before voluntarily discontinuing any benefit enhancement during a performance year.

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For each performance year, CMS shall pay the Company in accordance with the alternative payment mechanism, if any, for which CMS has approved the Company; the risk arrangement for which the Company has been approved by CMS; and as otherwise provided in the Participation Agreement. Following the end of each performance year and at such other times as may be required under the Participation Agreement, CMS will issue a settlement report to the Company setting forth the amount of any shared savings or shared losses and the amount of other monies owed. If CMS owes the Company shared savings or other monies owed, CMS shall pay the Company in full within 30 days after the date on which the relevant settlement report is deemed final, except as provided in the Participation Agreement. If the Company owes CMS shared losses or other monies owed as a result of a final settlement, the Company shall pay CMS in full within 30 days after the relevant settlement report is deemed final. If the Company fails to pay the amounts due to CMS in full within 30 days after the date of a demand letter or settlement report, CMS shall assess simple interest on the unpaid balance at the rate applicable to other Medicare debts under current provisions of law and applicable regulations. In addition, CMS and the U.S. Department of the Treasury may use any applicable debt collection tools available to collect any amounts owed by the Company.

The Company participates in the AIPBP track of the NGACO Model. Under the AIPBP track, CMS estimates the total annual expenditures for APAACO’s assigned patients and pays that projected amount to the Company in monthly installments, and the Company is responsible for all Part A and Part B costs for in-network participating providers and preferred providers contracted by the Company to provide services to the assigned patients.

As it relates specifically to the Company’s Participation Agreement with CMS, the Company recognizes capitation revenue in the month in which the Company is obligated to provide services. Also, because the Company’s arrangement with CMS is new (became effective in 2017), numerous factors create uncertainty regarding the risk pool settlement and incentive amounts that the Company is entitled to receive and limited historical data exists to develop reasonable and reliable estimates. As a result, the Company recognizes revenue from risk pool settlements and incentives under the arrangement with CMS in the period in which amounts are estimable and collection is reasonably assured. The Company will continue to evaluate and assess the reliability and reasonableness of data available to it in order develop future estimates, and will recognize risk pool settlements and incentives revenue based on such estimates only to the extent it is probable that a significant reversal of cumulative revenue will not occur in future periods.

In October 2017, CMS notified the Company that it would not be renewed for participation in the AIPBP payment mechanism of the NGACO Model for performance year 2018 due to certain alleged deficiencies in performance. The Company submitted a reconsideration request. In December 2017, the Company received the official decision on its reconsideration request that CMS reversed the prior decision against the Company’s continued participation in the AIPBP mechanism. As a result, the Company is eligible for receiving monthly AIPBP payments currently at a rate of approximately $7.3 million per month from CMS starting February 2018. The Company, however, will need to continue to comply with all terms and conditions in the Participation Agreement and various regulatory requirements to be eligible to participate in the AIPBP mechanism and/or NGACO Model.

Management Fee Income

Management fee income encompasses fees paid for management, physician advisory, healthcare staffing, administrative and other non-medical services provided by the Company to IPAs, hospitals and other healthcare providers. Such fees may be in the form of billings at agreed-upon hourly rates, percentages of revenue or fee collections, or amounts fixed on a monthly, quarterly or annual basis. The revenue may include variable arrangements measuring factors such as hours staffed, patient visits or collections per visit against benchmarks, and, in certain cases, may be subject to achieving quality metrics or fee collections. Such variable supplemental revenues are recognized as revenue in the period when such amounts are determined to be fixed and therefore contractually obligated as payable by the customer under the terms of the respective agreement. The Company’s MSA revenue also includes revenue sharing payments from the Company’s partners based on their non-medical services.

The Company provides a significant service of integrating the services selected by the Company’s clients into one overall output for which the client has contracted. Therefore, such management contracts generally contain a single performance obligation. The nature of the Company’s performance obligation is to stand ready to provide services over the contractual period. Also, the Company’s performance obligation forms a series of distinct periods of time over which the Company stands ready to perform. The Company’s performance obligation is satisfied as the Company completes each period’s obligations.

Consideration from management contracts is variable in nature because the majority of the fees are generally based on revenue or collections, which can vary from period to period. The Company has control over pricing. Contractual fees are invoiced to the Company’s clients generally monthly and payment terms are typically due within 30 days. The variable consideration in the Company’s management contracts meets the criteria to be allocated to the distinct period of time to which it relates because (i) it is due to the activities performed to satisfy the performance obligation during that period and (ii) it represents the consideration to which the Company expects to be entitled.

The Company’s management contracts generally have long terms (e.g., ten years), although they may be terminated earlier under the terms of the respective contracts. Since the remaining variable consideration will be allocated to a wholly unsatisfied promise that forms part of a single performance obligation recognized under the series guidance, the Company has applied the optional exemption to exclude disclosure of the allocation of the transaction price to remaining performance obligations. 

Medicare Shared Savings Program Surplus Revenue

The Company participated in the MSSP, which is sponsored by CMS. The goal of the MSSP is to improve the quality of patient care and outcomes through a more efficient and coordinated approach among providers. The MSSP allows ACO participants to share in cost savings it generates in connection with rendering medical services to Medicare patients. Payments to ACO participants, if any, will be calculated annually by CMS on cost savings generated by the ACO participant relative to the ACO participants’ cost savings benchmark. Revenues earned by the Company are uncertain, and, if such amounts are payable by CMS, they will be paid on an annual basis significantly after the time earned, and will be contingent on various factors, including achievement of the minimum savings rate as determined by MSSP for the relevant period. Such payments are earned and made on an “all or nothing” basis. The Company considers revenue, if any, under the MSSP, as contingent upon the realization of program savings as determined solely by CMS, which are subject to significant estimation risk. Accordingly, they are not recognized as revenue until the amounts are estimable and collection is reasonably assured, which is generally when notice is received from CMS that cash payments are to be imminently received.

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Fee-for-Service Revenue

FFS revenue represents revenue earned under contracts in which the Company bills and collects the professional component of charges for medical services rendered by the Company’s contracted physicians and employed physicians. Under the FFS arrangements, the Company bills the hospitals and third-party payors for the physician staffing and further bills patients or their third-party payors for patient care services provided and receives payment. FFS revenue related to the patient care services is reported net of contractual allowances and policy discounts and are recognized in the period in which the services are rendered to specific patients. All services provided are expected to result in cash flows and are therefore reflected as net revenue in the financial statements. The recognition of net revenue (gross charges less contractual allowances) from such services is dependent on such factors as proper completion of medical charts following a patient visit, the forwarding of such charts to the Company’s billing center for medical coding and entering into the Company’s billing system and the verification of each patient’s submission or representation at the time services are rendered as to the payor(s) responsible for payment of such services. Revenue is recorded based on the information known at the time of entering of such information into the Company’s billing systems as well as an estimate of the revenue associated with medical services.

The Company is responsible for confirming member eligibility, performing program utilization review, potentially directing payment to the provider and accepting the financial risk of loss associated with services rendered, as specified within the Company’s client contracts. The Company has the ability to adjust contractual fees with clients and possess the financial risk of loss in certain contractual obligations. These factors indicate the Company is the principal and, as such, the Company records gross fees contracted with clients in revenues.

Consideration from FFS arrangements is variable in nature because fees are based on patient encounters, credits due to clients and reimbursement of provider costs, all of which can vary from period to period. 

Contract Assets

Typically, revenues and receivables are recognized once the Company has satisfied its performance obligation. Accordingly, the Company’s contract assets comprise accounts receivable. Generally, the Company does not have material amounts of other contract assets.

Contract Liabilities (Deferred Revenue)

Contract liabilities are recorded when cash payments are received in advance of the Company’s performance, which is generally uncommon. The Company’s contract liability balance was $708,591 and $250,000 as of June 30, 2018 and December 31, 2017, respectively, and is presented within the “Accounts Payable and Accrued Expenses” line item of the condensed consolidated balance sheets. None of the amounts accrued as of December 31, 2017 was recognized as revenue for the three and six months ended June 30, 2018.

14.Income Taxes

 

On December 22, 2017, the U.S. government enacted comprehensive tax legislation known as the Tax Cuts and Jobs Act (the “TCJA”). The TCJA establishes new tax laws that will take effect in 2018, including, but not limited to (1) a reduction of the U.S. federal corporate tax rate from a maximum of 35% to 21%; (2) elimination of the corporate alternative minimum tax; (3) a new limitation on deductible interest expense; (4) limitations on the deductibility of certain executive compensation; (5) changes to the bonus depreciation rules for fixed asset additions; and (6) limitations on net operating losses generated after December 31, 2017, to 80% of taxable income.

ASC 740, Income Taxes, generally requires the effects of changes in tax laws to be recognized in the period in which the legislation is enacted. However, due to the complexity and significance of the TCJA’s provisions, the SEC staff issued Staff Accounting Bulletin 118 (“SAB 118”), which provides guidance on accounting for the tax effects of the TCJA. SAB 118 provides a measurement period that should not extend beyond one year from the TCJA enactment date for companies to complete the accounting under ASC 740. In accordance with SAB 118, a company must reflect the income tax effects of those aspects of the TCJA for which the accounting under ASC 740 is complete. To the extent that a company’s accounting for certain income tax effects of the TCJA is incomplete but it is able to determine a reasonable estimate, it must record a provisional estimate in the financial statements. If a company cannot determine a provisional estimate to be included in the financial statements, it should continue to apply ASC 740 on the basis of the provisions of the tax laws that were in effect immediately before the enactment of the TCJA.

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At June 30, 2018 and December 31, 2017, the Company did not complete its accounting for the tax effects of enactment of the TCJA because the Internal Revenue Service has not issued all guidance for the TCJA; however, the Company has made a reasonable estimate of the effects of the TCJA’s change in the federal rate and revalued its deferred tax assets based on the rates at which they are expected to reverse in the future, which is generally the new 21% federal corporate tax rate plus applicable state tax rate. The Company recorded a decrease in its deferred tax assets and deferred tax liabilities of $6.6 million and $16.3 million, respectively, with a corresponding net adjustment to deferred income tax benefit of $9.7 million, for the year ended December 31, 2017. The Company’s provisional estimates are expected to be adjusted during the measurement period defined under SAB 118, based upon ongoing analysis of data and tax positions along with the new guidance from regulators and interpretations of the TCJA. The Company uses the liability method of accounting for income taxes as set forth in ASC 740. Under the liability method, deferred taxes are determined based on the differences between the Company’s financial statementstatements and tax bases of assets and liabilities using enacted tax rates.

 

On an interim basis, the Company estimates what its anticipated annual effective tax rate will be and records a quarterly income tax provision (benefit) in accordance with the estimated annual rate, plus the tax effect of certain discrete items that arise during the quarter. As the fiscal year progresses, the Company refines its estimates based on actual events and financial results during the quarter. This process can result in significant changes to the Company’s estimated effective tax rate. WhenIf and when this occurs, the income tax provision (benefit) iswill be adjusted during the quarter in which the estimates are refined so that the year-to-date provision reflects the estimated annual effective tax rate. These changes, along with adjustments to the Company’s deferred taxes and related valuation allowance, may create fluctuations in the Company’s overall effective tax rate from quarter to quarter.

DueAs of June 30, 2018, due to overall cumulative losses incurred, prior to the merger with NMM, in recent years, the Company maintained a full valuation allowance against its deferred tax assets related to loss entities the Company cannot consolidate under the Federal consolidation rules, as realization of September 30, 2017 and March 31, 2017.

these assets is uncertain. The Company’s effective tax rate for the three and six months ended SeptemberJune 30, 20172018 differed from the U.S. federal statutory rate primarily due to operating losses that receive no tax benefit as a result of a valuation allowance recorded for such lossesstate income taxes, prior period true up adjustments and the exclusionexcess tax benefits of loss entities from the Company’s overall estimated annual effective rate calculation under guidance from ASC 740-270-30-26a.

stock-based compensation. As of SeptemberJune 30, 2017 and March 31, 2017,2018, the Company does not have any unrecognized tax benefits related to various federal and state income tax matters. The Company will recognize accrued interest and penalties related to unrecognized tax benefits in income tax expense.

 

The Company is subject to U.S. federal income tax as well as income tax of multiple state tax jurisdictions.in California. The Company and its subsidiaries’ state and Federal income tax returns are open to audit under the statute of limitations for the years ended JanuaryDecember 31, 2013 onwards.through December 31, 2016 and for the years ended December 31, 2014 through December 31, 2016, respectively. The Company currently does not anticipate material unrecognized tax benefits within the next 12 months.

 


6.15.Stockholders’ EquityEarnings Per Share

 

Series A Preferred Stock

On October 14, 2015,Basic net income per share is calculated using the Company entered into a Securities Purchase Agreement (the “2015 SPA”) with NMM pursuant to which the Company sold to NMM, and NMM purchased from the Company, in a private offeringweighted average number of securities, 1,111,111 units, each unit consisting of one share of the Company’s Series A Preferred Stock and a stock purchase warrant (the “Series A Warrant”) to purchase one shareshares of the Company’s common stock issued and outstanding during a certain period, and is calculated by dividing net income by the weighted average number of shares of the Company’s common stock issued and outstanding during such period. Diluted net income per share is calculated using the weighted average number of shares of common stock and potentially dilutive shares of common stock outstanding during the period, using the as-if converted method for secured convertible notes, preferred stock, and the treasury stock method for options and common stock warrants.

Pursuant to the Merger Agreement, ApolloMed held back 10% of the shares of its common stock that were issuable to NMM shareholders (“Common Stock”Holdback Shares”) at an exercise priceto secure indemnification of $9.00ApolloMed and its affiliates under the Merger Agreement. The Holdback Shares will be held for a period of up to 24 months after the closing of the Merger (to be distributed on a pro-rata basis to former NMM shareholders), during which ApolloMed may seek indemnification for any breach of, or noncompliance with, any provision of the Merger Agreement, by NMM. The Holdback Shares are excluded from the computation of basic earnings per share, but included in diluted earnings per share. The Series A Preferred Stock has a liquidation preferenceAs of both June 30, 2018 and 2017, APC held 1,682,110 shares of ApolloMed’s and NMM’s common stock, which are treated as treasury shares for accounting purposes and not included in the amount of $9.00 per share plus any declared and unpaid dividends. The Series A Preferred Stock can be voted for the number of shares of Common Stock into which the Series A Preferred Stock could then be converted, which initiallycommon stock outstanding used to calculate earnings per share (see Note 10).

Below is one-for-one. The Series A Preferred Stock is convertible into Common Stock, at the option of NMM, at any time after issuance at an initial conversion rate of one-for-one, subject to adjustment in the event of stock dividends, stock splits and certain other similar transactions. The Series A Preferred Stock is mandatorily convertible not sooner than the earlier to occur of (i) the later of (x) January 31, 2017 or (y) 60 days after the date on which the Company files its quarterly report on Form 10-Q for the period ending September 30, 2016, or (ii) the date on which the Company receives the written, irrevocable decision of NMM not to require a redemptionsummary of the Series A Preferred Stock, if the Company receive aggregate gross proceeds of not less than $5,000,000 in one or more transactions for the saleearnings per share computations:

Three Months Ended June 30, 2018  2017 
       
Earnings per share – basic $0.08  $0.08 
Earnings per share – diluted $0.07  $0.07 
Weighted average shares of common stock outstanding – basic  32,674,459   25,067,954 
Weighted average shares of common stock outstanding – diluted  37,850,679   28,417,877 

Six Months Ended June 30, 2018  2017 
       
Earnings per share – basic $0.15  $0.25 
Earnings per share – diluted $0.13  $0.22 
Weighted average shares of common stock outstanding – basic  32,548,662   25,067,954 
Weighted average shares of common stock outstanding – diluted  37,935,773   28,417,877 

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Below is a summary of the Company’s equity or convertible securities (other than transactions with NMM). The Company has not received at least $5,000,000 in one or more transactions for the sale of its equity or convertible securities to parties other than NMM. The Series A Warrant may be exercised at any time after issuance and through October 14, 2020, for $9.00 per share, subject to adjustment in the event of stock dividends and stock splits. The Series A Warrant is not separately transferable from the Series A Preferred Stock. See Note 2 for information on the fair value of the Series A Warrant. The units sold to NMM under the 2015 SPA initially had a redemption feature, however, as part of the proposed Merger between NMM and the Company (see Note 10), NMM entered into a Consent and Waiver Agreement dated December 21, 2016 (the “NMM Waiver”), pursuant to which NMM has relinquished its right of redemption with respect to its shares of Series A Preferred Stock and Series A Warrants.

Series B Preferred Stock

On March 30, 2016, the Company entered into an additional Securities Purchase Agreement (the “2016 SPA”) with NMM pursuant to which the Company sold to NMM, and NMM purchased from the Company, in a private offering of securities, 555,555 units, each unit consisting of one share of the Company’s Series B Preferred Stock and a stock purchase warrant (the “Series B Warrant”) to purchase one share of Common Stock at an exercise price of $10.00 per share. NMM paid the Company an aggregate $4,999,995 for the units. The Series B Preferred Stock has a liquidation preference in the amount of $9.00 per share plus any declared and unpaid dividends. The Series B can be voted for the number of shares of Common Stock into which the Series B Preferred Stock could then be converted, which initially is one-for-one. The Series B Preferred Stock is convertible into Common Stock, (i) at the option of NMM or (ii) mandatorily at any time prior to and including March 30, 2021, if the Company receives aggregate gross proceeds of not less than $5,000,000 in one or more transactions for the sale of the Company’s equity or convertible securities (other than transactions with NMM), at an initial conversion rate of one-for-one, subject to adjustment in the event of stock dividends, stock splits and certain other similar transactions. The Company has not received at least $5,000,000 in one or more transactions for the sale of its equity or convertible securities to parties other than NMM. The Series B Warrant may be exercised at any time after issuance and through March 30, 2021, for $10.00 per share, subject to adjustment in the event of stock dividends and stock splits. The Series B Warrant is not separately transferable from the Series B Preferred Stock. See Note 2 for information on the fair value of the Series B Warrant.

Common Stock Issuance

During the three months ended September 30, 2017, the Company received warrant exercise notices and proceeds with respect to 19,000 shares of Common Stock. The number of shares of Common Stock that are issued and outstanding as of September 30 and March 31, 2017 is 6,052,518 and 6,033,518, respectively. Common Stock is currently quoted on OTC Pink and traded under the symbol “AMEH.” The Company has applied for listing of its common stock on the NASDAQ Global Market effective as of the closing of the Merger. No assurance can be given that ApolloMed can meet the listing requirements for the NASDAQ Global Market, including at the closing of the Merger, or that ApolloMed’s application will ever be approved.

Equity Incentive Plans

On December 15, 2015, the Company’s Board of Directors (the “Board”) approved the Company’s 2015 Equity Incentive Plan (the “2015 Plan”), pursuant to which 1,500,000 shares of Common Stock were reserved for issuance thereunder. In addition, shares that are subject to outstanding grants under the Company’s 2010 Equity Incentive Plan and 2013 Equity Incentive Plan but that ordinarily would have been restored to such plans reserve due to award forfeitures and terminations will roll into and become available for awards under the 2015 Plan. The 2015 Plan provides for awards, including incentive stock options, non-qualified options, restricted common stock, and stock appreciation rights. The 2015 Plan was approved by the Company’s stockholders at the 2016 Annual Meeting of Stockholders that was held on September 14, 2016. As of September 30, 2017, there were approximately 941,000 shares available for future grants under the 2015 Plan. As of September 30, 2017, there were no shares available for future grants under the 2010 and 2013 Equity Incentive Plans. In May 2017, the Company filed an application with the California Department of Business Oversight (“DBO”), seeking qualification of securities issued under its 2010 and 2015 Equity Incentive Plans under California securities laws. On November 1, 2017, the DBO approved the Company’s qualification application, which qualification will continue to be effective until November 1, 2018.


Options

On April 6, 2017, the Company granted stock options to employees and a director to purchase up to 80,000 shares of Common Stock. Two of the options expire on the 5th anniversary date from date of grant and have an exercise price of $10.18 per share. The remaining options expire on the 10th anniversary date from date of grant and have an exercise price of $9.25 per share. The fair value of the stock option of $572,000 was computed using the Black-Scholes option pricing model, using the following assumptions: expected term – 3-6 years; stock price $9.25 per share; volatility – 109.95% - 134.83%; risk-free interest rate – 1.53% - 2.09%; and zero annual rate of quarterly dividend. All of these stock options vest over a period of 24 months from date of grant.

Stock option activity for the six months ended September 30, 2017 is summarized below:

  Shares  Weighted
Average
Per Share
Exercise
Price
  Weighted
Average
Remaining
Life
(Years)
  Weighted
Average
Per Share
Intrinsic
Value
 
Balance, March 31, 2017  1,165,350  $4.24   6.64  $4.86 
Granted  80,000   9.71   -   - 
Exercised  -   -   -   - 
Cancelled/expired  (33,000)  9.62   -   - 
Balance, September 30, 2017  1,212,350  $4.42   6.36  $5.35 
Vested, September 30, 2017  1,040,840  $4.04   5.92  $5.74 

As of September 30, 2017, total unrecognized compensation cost related to non-vested stock-based compensation arrangements granted under the Company’s three Equity Incentive Plans was approximately $616,000 and the weighted-average period of years expected to recognize those costs was 1.6 years, which included stock options granted to our executive officers in April 2017 that have subsequently been deemed void and are currently planned to be cancelled without payment by the Company. Until the options are formally cancelled, the Company will continue to accrue compensation cost. The compensation cost with respect to the April 2017 stock options for the six months ended September 30, 2017 was approximately $143,000. None of such stock options have been exercised.

Stock-based compensation expense related to common stock option awards is recognized over their respective vesting periods and was included in the accompanying condensed consolidated statement of operations as follows:

  Three Months Ended
September 30,
  Six Months Ended
September 30,
 
  2017  2016  2017  2016 
Stock-based compensation expense:                
Cost of services $-  $1,227  $-  $2,454 
General and administrative  195,244   244,814   418,810   491,304 
  $195,244  $246,041  $418,810  $493,758 

Warrantsdiluted earnings per share computations:

 

Warrants consisted

Three Months Ended June 30, 2018  2017 
       
Weighted average shares of common stock outstanding – basic  32,674,459   25,067,954 
10% shares held back pursuant to indemnification clause  3,039,609   2,785,328 
Stock options  692,506   564,595 
Warrants  1,444,105   - 
Weighted average shares of common stock outstanding – diluted  37,850,679   28,417,877 

Six Months Ended June 30, 2018  2017 
       
Weighted average shares of common stock outstanding – basic  32,548,662   25,067,954 
10% shares held back pursuant to indemnification clause  3,039,609   2,785,328 
Stock options  720,103   564,595 
Warrants  1,627,399   - 
Weighted average shares of common stock outstanding – diluted  37,935,773   28,417,877 

16.Variable Interest Entities (VIEs)

A VIE is defined as a legal entity whose equity owners do not have sufficient equity at risk, or, as a group, the holders of the equity investment at risk lack any of the following forthree characteristics: decision-making rights, the six months ended September 30, 2017:obligation to absorb losses, or the right to receive the expected residual returns of the entity. The primary beneficiary is identified as the variable interest holder that has both the power to direct the activities of the VIE that most significantly affect the entity’s economic performance and the obligation to absorb expected losses or the right to receive benefits from the entity that could potentially be significant to the VIE.

 

  Weighted
Average
Per Share
    
  Intrinsic  Number of 
  Value  Warrants 
Outstanding at March 31, 2017 $4.68   1,970,166 
Granted  -   - 
Exercised  5.09   (19,000)
Cancelled  -   - 
Outstanding at September 30, 2017 $1.34   1,951,166 


      Weighted     Weighted 
      Average     Average 
Exercise Price Per  Warrants  Remaining  Warrants  Exercise Price Per 
Share  Outstanding  Contractual Life  Exercisable  Share 
              
 $4.00-$5.00   169,500[1]  0.39   169,500   4.46 
 $9.00-$10.00   1,781,666[2]  3.04   1,781,666   9.37 
                   
 $4.00-$10.00   1,951,166   2.81   1,951,166  $8.94 

[1]Such warrants outstanding as of September 30, 2017 comprise warrants issued in October 2009 in connection with theThe Company’s 10% Senior Subordinated Callable Convertible NotesVIEs include APC and warrants issued in January 2013 in connection with the Company’s 9% Senior Subordinated Callable Convertible Promissory Notes. The 2009 warrants have expired as of the date of this Quarterly Report on Form 10-Q. The 2013 warrants may be exercised at an exercise price of $4.50 per share at any time until the end of January 2018. In addition, in November, 2016, in connection with the acquisition of BAHA, the Company issued to Scott Enderby, D.O., a warrant to purchase 24,000 shares of Common Stock at an exercise price of $4.50 per share.

[2]In July 2014, in connection with the acquisition of SCHC, the Company issued to Stanley Lau, M.D., and Yih Jen Kok, M.D., warrants to purchase up to 100,000 shares of Common Stock (on a post stock-split basis) at an exercise price of $10.00 per share exercisable until July 21, 2018. In February 2015, in consideration of services rendered to the Company, the Company issued to RedChip Companies, Inc. a warrant to purchase up to 10,000 shares of Common Stock (on a post stock-split basis) at an exercise price of $9.00 per share exercisable until February 20, 2018. In connection with NMM’s investments in the Company, in October, 2015 and March 2016, respectively, the Company issued to NMM a stock purchase warrant (the “Series A Warrant”) to purchase up to 1,111,111 shares of Common Stock at an exercise price of $9.00 per share, and a stock purchase warrant (the “Series B Warrant”) to purchase up to 555,555 shares of Common Stock at an exercise price of $10.00 per share. In November, 2016, in connection with a promissory note issued to Liviu Chindris, M.D., which the Company has repaid in full, the Company issued to Dr. Chindris a warrant to purchase up to 5,000 shares of Common Stock at an exercise price of $9.00 per share.other immaterial entities.

 

During the second quarter of fiscal year 2018, the Company received notices for, and proceeds of approximately $85,000 from, the exercise of warrants to purchase to 19,000 shares of Common Stock. In addition, during September 2017, the Company received notices for the exercise of warrants to purchase 21,000 shares of Common Stock for approximately $94,500. The Company, however, had not received proceeds from such exercise, andAssets recognized as a result of consolidating these VIEs do not represent additional assets that could be used to satisfy claims against the related shares wereCompany’s general assets. Conversely, liabilities recognized as a result of consolidating these VIEs do not recorded as issued and outstanding.

Authorized Stock

Asrepresent additional claims on the Company’s general assets; rather, they represent claims against the specific assets of September 30, 2017, the Company was authorized to issue up to 100,000,000 shares of Common Stock and 5,000,000 shares of its preferred stock.

The number of shares of Series A Preferred Stock and Series B Preferred Stock that are issued and outstanding as of September 30, 2017 is 1,111,111 and 555,555, respectively. The number of shares of Common Stock that are issued and outstanding as of September 30, 2017 is 6,052,518.VIE.

 

The Company is requiredevaluates its relationships with its VIEs on an ongoing basis to reserve and keep available out of the authorized but unissued shares of Common Stock such number of shares sufficient to affect the conversion of all outstanding preferred stock, the exercise of all outstanding warrants exercisable into shares of Common Stock, the conversion of all outstanding notes and accrued interest into shares of Common Stock, and shares granted and available for grant as stock options under the Company’s Equity Incentive Plans. The number of shares of Common Stock reserved for these purposes is as follows as of September 30, 2017:

For warrants outstanding1,951,166
For stock options outstanding1,212,350
For debt outstanding and accrued interest514,093
For preferred stock issued and outstanding1,666,666
Total5,344,275

23 

7.Debt

Standby Letters of Credit and Lines of Credit

In January 2013, City National Bank (“CNB”) provided to MMG an irrevocable standby letter of credit for $10,000, which was increased to $500,000 in November, 2014. Such letter of credit renews automatically every 5 months. In December 2016, CNB provided to MMG another irrevocable standby letter of credit for $235,000, which expires December 31, 2017. In March 2017, APAACO established an irrevocable standby letter of credit with a financial institution for $6,699,329 for the benefit of CMS, which expires on December 31, 2018 and will be automatically extended without amendment for additional one-year periods, unless terminated by the institution prior to 90 days from the expiration date. The standby letters of credit are typically collateralized by cash deposits, which are included in restricted cash in the amount of $745,176 and $765,058 on the consolidated balance sheets as of September 30, 2017 and March 31, 2017, respectively.

BAHA has a line of credit of $150,000 with First Republic Bank. Borrowings thereunder bear interest at the prime rate (as defined) plus 3.0% (7.25% and 7.0% per annum at September 30, 2017 and March 31, 2017, respectively). The Company has an outstanding balanceof $25,000 and $62,500 as of September 30, 2017 and March 31, 2017, respectively. The line of credit is unsecured.

Restated NMM Note (Related Party)

In connection with the proposed Merger, on January 3, 2017, the Company issued a promissory note to NMM in the amount of $5,000,000 (the “NMM Note”). Interest was due quarterly at the rate of prime plus 1% (or 5.25% at September 30, 2017), with the entire principal balance being due on January 3, 2019. In the event of default, as defined, all unpaid principal and interest will become due and payable.

In connection with the Merger Agreement Amendment No. 2 (see Note 1 “Overview” above and Note 10 “Subsequent Events” below), on October 17, 2017, the original NMM Note was amended and restated (the “Restated NMM Note”) to include, among others, (i) an additional $4,000,000ensure that it continues to be used for working capital, (ii) an extension of the maturity date to the earlier of (A) March 31, 2019 or (B) 12 months after the date the Merger Agreement is terminated (the “Restated NMM Note Maturity Date”), (iii) the increase in the principal amount of the Restated NMM Note to $13,990,000 if the Company fails to pay the Amended Alliance Note (see “Amended Alliance Note” below), in which case NMM will either pay all amounts owed under the Amended Alliance Note or enter into another agreement with Alliance (such that in either case the Amended Alliance Note is cancelled), and (iv) a conversion feature allowing the Restated NMM Note to be converted into shares of Common Stock at $10.00 per share (subject to adjustment for stock splits, dividends, recapitalizations and the like) with such conversion, if exercised in accordance with the terms of the Restated NMM Note, becoming effective on the maturity date.

Under the terms of the Restated NMM Note, the Company must pay NMM successive quarterly installments comprising all accrued and unpaid interest on the principal balance outstanding at the prime rate (as such term is defined in the Restated NMM Note) plus 1%. All outstanding principal and accrued but unpaid interest under the Restated NMM Note is due and payable in full on the Restated NMM Note Maturity Date. The Company may voluntarily prepay the outstanding principal and interest in whole or in part without penalty or premium. Upon the occurrence of an event of default (as such term is defined in the Restated NMM Note), the unpaid principal amount of, and all accrued but unpaid interest on, the Restated NMM Note will become due and payable immediately at the option of NMM. In such event, NMM may, at its option, declare the entire unpaid balance of the Restated NMM Note, together with all accrued interest, applicable fees, and costs and charges, including costs of collection, if any, to be immediately due and payable in cash.

Interest expense associated with the outstanding notes payable amounted to $70,243 and $134,336 for the three and six months ended September 30, 2017, respectively. There was no interest on these notes for the three and six months ended September 30, 2016.

Amended Alliance Note

On March 30, 3017, the Company issued a 6% convertible promissory note to Alliance Apex, LLC (“Alliance”) in the principal amount of $4,990,000 (the “Alliance Note”). On October 16, 2017, the Company and Alliance amended the Alliance Note (the “Amended Alliance Note”) (see Note 10 “Subsequent Events” below). The Amended Alliance Note is due and payable to Alliance on (i) March 31, 2018, or (ii) the date on which the Merger Agreement with NMM is terminated (see Note 1 above), whichever occurs first. Upon the closing of the proposed Merger on or before March 31, 2018, the Amended Alliance Note together with the accrued and unpaid interest, shall automatically be converted into 499,000 shares of Common Stock, at a conversion price of $10.00 per share, subject to adjustment for stock splits, stock dividends, reclassifications and other similar recapitalization transactions. If the Merger is not consummated by March 31, 2018, the Company will be obligated to repay the outstanding principal, together with accrued and unpaid interest, on the Amended Alliance Note within 45 days, which would require a significant amount of cash on hand or the need to raise capital to pay off or refinance the Amended Alliance Note. There can be no assurance that is such event arose, the Company would have sufficient cash on hand to repay the Amended Alliance Note or could raise capital on favorable terms, or at all, to repay the Amended Alliance Note.

In the case of an event of default (as defined in the Alliance Note), the entire outstanding principal and all accrued and unpaid interest under the Alliance Note shall automatically become immediately due and payable, without presentment, demand, protest or notice of any kind. If any other event of default occurs and is continuing, Alliance, by written notice to the Company, may declare the outstanding principal and interest under the Alliance Note to be immediately due and payable. After maturity (by acceleration or otherwise), the unpaid balance (both as to principal and unpaid pre-maturity interest) shall bear interest at a default rate equal to the lesser of (a) 3% over the rate of interest in effect immediately prior to maturity or (ii) the then maximum legal rate allowed under the laws of the State of California. Additionally, the Company shall pay all costs of collection incurred by Alliance, including reasonable attorney’s fees incurred in connection with the Alliance’s reasonable collection efforts. These terms equally apply to the Amended Alliance Note.


As part of the Merger Agreement Amendments No. 1 and No. 2 (see Note 1 “Overview” above), NMM provided a guarantee for the Alliance Note and Amended Alliance Note, which guarantee was considered a debt issuance cost. The Company estimated the debt issuance cost and related warrants issuable for the debt guarantee of $161,000 based on the incremental fair value to a market participant of a similar but unsecured debt instrument without such guarantee using a market rate for an unsecured high yield note of 12.4% and a 25% probability of the note not being converted. As of September 30, 2017 and March 31, 2017, the debt issuance cost associated with the guarantee was approximately $54,000 and $161,000, respectively, and after being offset against the Alliance Note, resulted in a net balance of approximately $4,936,000 and $4,829,000, respectively.

8.Commitments and Contingencies

Standby Letters of Credit, Lines of Credit and Outstanding Notes

See Note 7 - “Debt - Standby Letters of Credit and Lines of Credit” above.

Lease Commitments

The Company’s lease for its current corporate headquarters, as amended, sets base rent at $37,913 per month for the first year and schedules annual increases in base rent each year until the final rental year, which is capped at $43,957 per month. The base rent may be abated by up to $228,049 subject to other terms of the lease. As of September 30, 2017, deferred rent liability associated with such leases was approximately $648,000.

Employment Agreements

In December 2016, AMM entered into employment agreements with Warren Hosseinion, M.D., Adrian Vazquez, M.D., Gary Augusta and Mihir Shah, which replaced such officers’ previous employment agreements and revised certain term, bonus and severance arrangements. Such agreements, as amended as of the date of this Report, provide annual base salaries in the aggregate amount of $1,550,000 for such officers. Each of the new employment agreements has an initial term of three years with automatic annual renewals and provide 20 business days of paid time off per calendar year. Accrued and unused paid time off shall be paid in cash at the end of each calendar year. Under the new employment agreements, each officer is eligible to receive an annual bonus and is granted certain vesting rights and accrued benefits (as such term is defined therein) if his employment is terminated without “cause” (as such term is defined therein) or if he resigns with “good reason” (as such term is defined therein) during the employment term.

Regulatory Mattersprimary beneficiary.

 

The healthcare industry and Medicare and Medicaid programs are subjectfollowing table includes assets that can only be used to numerous laws and regulationssettle the liabilities of federal, state and local governments, including the Health Insurance Portability and Accountability Act, the Health Information Technology for Economic and Clinical Health ActAPC and the Patient Protectioncreditors of APC have no recourse to the Company. These assets and Affordable Care Act,liabilities, with the exception of the investment in a privately held entity that does not report net asset value per share and amounts due to affiliate, which are generally are complex and subject to interpretation. These laws and regulations govern matters such as licensure, accreditation, security and privacy of health information, health insurance portability, health insurance exchanges, government healthcare program participation requirements, reimbursement for patient services, and Medicare and Medicaid fraud and abuse. Government activity has continued with respect to investigations and allegations concerning possible violations of such laws and regulations by healthcare providers. Compliance with such laws and regulations can be subject to government review and interpretation. Violations of these laws and regulations may result in significant adverse regulatory actions, including fines, penalties, exclusion from government healthcare programs, repayments for patient services previously billed as well as those unknown or unasserted at this time.

As a risk-bearing organization (“RBO”), the Company is required to follow regulations of the California Department of Managed Health Care (“DMHC”). The Company and its applicable affiliates must comply with a minimum working capital requirement, Tangible Net Equity (“TNE”) requirement, cash-to-claims ratio and claims payment requirements prescribed by the DMHC. TNE is defined as net assets less intangibles, less non-allowable assets (which include amounts due from affiliates), plus subordinated obligations. The DMHC determined that, as of February 28, 2016, MMG, was not in complianceeliminated upon consolidation with the DMHC’s positive TNE requirement for a RBO. As a result, the DMHC required MMG to develop and implement a corrective action plan (“CAP”) for such deficiency. MMG’s CAP has been submitted and was approved by DMHC in December 2016. Through a $2,000,000 intercompany revolving subordinate loan from AMM dated November 22, 2016, where AMM agreed to subordinate to other creditors its right in and to the repayment of the revolving loan, MMG achieved positive TNE in the third quarter of fiscal year 2017 and has maintained positive TNE to date. The DMHC is in the process of reviewing the Company’s filings for MMG to be taken off the CAP. As of the date of this Quarterly Report on Form 10-Q, the DMHC staff has indicated to the Company that it has no objections to the closing of the CAP. On August 31, 2017, AMM and MMG entered into an amendment to the intercompany revolving loan, increasing the revolving loan commitment from $2,000,000 to $3,000,000.


In addition, the Company has from time to time issued securities to investors to raise capital and as compensation to directors, employees and consultants to attract and retain talent. As a result, the Company is subject to federal and state securities laws. Non-compliance with such laws, such as its failing to file information statements for two corporate actions taken by its majority stockholders in written consents in 2012 and 2013, could cause federal or state agencies to take action against the Company, including restricting its ability to issue securities or imposing fines or penalties on it.

Legal Actions and Proceedings

In the ordinary course of the Company’s business, the Company from time to time becomes involved in pending and threatened legal actions and proceedings, most of which involve claims of medical malpractice related to medical services provided by the Company’s affiliated hospitalists. The Company may also become subject to other lawsuits which could involve significant claims and/or significant defense costs. See “Potential Third-Party Claims” below. Many of the Company’s payer and provider contractsNMM, are complex in nature and may be subject to differing interpretations regarding amounts due for the provision of medical services, which may not come to light until a substantial period of time has passed following contract implementation. Liabilities for claims are recorded when the loss is probable and can be estimated. Any adjustments to reserves are reflected in current operations. As of the date of this Quarterly Report on Form 10-Q, the Company is not a party to any legal proceedings, which the Company expects individually or in the aggregate to have a material adverse effect on the Company’s financial condition, cash flows or results of operations. Nonetheless, the resolution of any claim or litigation is subject to inherent uncertainty and could have a material adverse effect on the Company’s financial condition, cash flows or results of operations.

Potential Third-Party Claims

Monteverde & Associates PC, a plaintiffs’ securities law firm, has announced that it is investigating the Company and its board of directors for potential federal law violations and/or breaches of fiduciary duties in connection the Merger. This investigation purportedly focuses on whether the Company and/or its board of directors violated federal securities laws and/or breached their fiduciary duties to the Company’s stockholders by failing to properly value the Merger and failing to disclose all material information in connection with the Merger. While the Company believes that its board of directors and management have faithfully upheld their fiduciary duties in negotiating and executing the Merger for the combined interest of all of the Company’s stockholders, the Company cannot preclude the possibility that this investigation may lead to legal actions and proceedings against the Company.

Liability Insurance

Although the Company currently maintains liability insurance policies on a claims-made basis, which are mainly intended to cover malpractice liability and certain other claims, the coverage must be renewed annually, and may not continue to be available to the Company in future years at acceptable costs, and on favorable terms. In addition, the Company cannot be certain that the Company’s current insurance coverage will be adequate to cover liabilities arising out of claims asserted against the Company, the Company’s affiliated professional organizations or the Company’s affiliated hospitalists in the future where the outcomes of such claims are unfavorable. Liabilities in excess of the Company’s insurance coverage may have a material adverse effect on the Company’s business, financial position, results of operations and cash flows.

9.Related Party Transactions

Dr. Thomas Lam, one of the Company’s directors is a significant shareholder and the Chief Executive Officer of NMM. See Note 1 for information on the proposed Merger and NMM’s investments in and loan to the Company.

Mark Fawcett, one of the Company’s directors, was nominated by NNA as its representative on the Board. See Note 10 for information in relation to NNA’s registration rights granted by the Company.

In September 2015, the Company entered into a note receivable with Rob Mikitarian, a minority owner in APS, in the amount of approximately $150,000. The note accrues interest at 3% per annum and is due on or before September 2017. At both September 30, 2017 and March 31, 2017, the balance of the note was approximately $150,000 and is included in other receivables in the accompanying consolidated balance sheets.

 

39

In September 2015, the Company entered into a note receivable with Liviu Chindris, M.D., a minority owner in APS, in the amount of approximately $105,000. The note accrues interest at 3% per annum and is due on or before September 2017. As of September 30, 2017, the balance of the note has been paid; and at March 31, 2017, the balance of the note was approximately $105,000 and was included in other receivables in the accompanying consolidated balance sheets. In November, 2016, in connection with a promissory note issued to Dr. Chindris, which the Company has repaid in full, the Company issued Dr. Chindris a warrant to purchase up to 5,000 shares of Common Stock at an exercise price of $9.00 per share, which warrant is currently outstanding (see Note 6 “Stockholders’ Equity - Warrants” above).

  June 30,
2018
  December 31,
2017
 
       
Assets        
         
Current assets        
Cash and cash equivalents $46,405,310  $54,686,370 
Restricted cash – short-term  8,040,870   18,005,661 
Fiduciary cash  1,294,503   2,017,437 
Investment in marketable securities  1,061,022   1,057,090 
Receivables, net  28,601,680   15,183,483 
Prepaid expenses and other current assets  1,531,872   1,821,328 
         
Total current assets  86,935,257   92,771,369 
         
Noncurrent assets        
Land, property and equipment, net  9,990,830   10,167,689 
Intangible assets, net  64,683,046   70,841,907 
Goodwill  60,012,316   60,012,316 
Loans receivable – related parties  7,500,000   5,000,000 
Loan receivable  5,000,000   5,000,000 
Investment in a privately held entity that does not report net asset value per share  4,725,000   4,320,000 
Investments in other entities – equity method  23,545,361   21,903,524 
Investment in joint venture – equity method  8,336,920   - 
Restricted cash – long-term  745,352   745,235 
Other assets  1,063,539   1,371,664 
         
Total noncurrent assets  185,602,364   179,362,335 
         
Total assets $272,537,621  $272,133,704 
Current liabilities        
Accounts payable and accrued expenses $3,895,202  $3,625,610 
Incentives payable  5,000,000   21,500,000 
Fiduciary accounts payable  1,294,503   2,017,437 
Medical liabilities  20,243,608   25,186,240 
Income taxes payable  2,882,773   1,463,540 
Amount due to affiliate  17,624,486   24,889,717 
Bank loan, short-term  278,017   510,391 
Capital lease obligations  100,228   98,738 
         
Total current liabilities  51,318,817   79,291,673 
         
Noncurrent liabilities        
Deferred tax liability  24,033,663   20,970,766 
Liability for unissued equity shares  1,185,025   1,185,025 
Dividend payable  617,210   - 
Capital lease obligations, net of current portion  568,512   619,001 
         
Total noncurrent liabilities  26,404,410   22,774,792 
         
Total liabilities $77,723,227  $102,066,465 

 

During the three and six months ended September 30, 2017, the Company billed NMM approximately $0 and $400,000, respectively, for its 50% share of the costs related to APAACO’s participation in the NGACO Model that the Company had incurred on behalf of APAACO.


In the ordinary courseThe assets of the Company’s business, the Company, from time to time, grants options to its employees under its Equity Incentive Plans and enters into employment agreements with its employees, including officers. See Note 6 and Note 8 above for addition information.other consolidated VIEs were not considered significant.

 

In addition, affiliates wholly-owned by the Company’s officers, including Dr. Hosseinion, are reported in the accompanying condensed consolidated statementAs of operations onJune 30, 2018 and December 31, 2017, approximately $8,000,000 and $18,000,000, respectively, of restricted cash is related to an amount that, as a consolidated basis, together with the Company’s subsidiaries, and therefore, the Company does not separately disclose transactions between such affiliates and the Company’s subsidiaries as related party transactions.

10.Subsequent Events

Amendment No.2 to the Merger Agreement, NMM Note Restatement and Alliance Note Amendment

On October 17, 2017, NMM and the Company entered into an second amendment (the “Merger Agreement Amendment No. 2”) to the Merger Agreement to include, in addition to such number of shares of Common Stock that represents 82% of the total issued and outstanding shares of Common Stock immediately following the consummationresult of the Merger between ApolloMed and warrants to purchase 850,000 shares of Common Stock at an exercise price of $11 per share, the following as NMM shareholders’ merger consideration payable at the closing of the Merger: an aggregate of 2,566,666 common shares and five-year warrants to purchase an aggregate of 900,000 shares of Common Stock exercisable at $10.00 per share, Pursuant to the Merger Agreement Amendment No. 2, NMM also agreed to provide an additional $4,000,000 capital loan to the Company as evidenced by a convertible promissory note in the principal amount of $9,000,000 (the “Restated NMM Note”), which replaces the NMM Note in the principal amount of $5,000,000 (see Note 7 “Debt - Restated3), was held for distribution to former NMM Note” above). The Merger Agreement Amendment No. 2 also extended the “End Date” (as defined in the Merger Agreement) from August 31, 2017 to March 31, 2018.shareholders.

 

On October 17, 2017, concurrent with the execution of the Merger Agreement Amendment No. 2, the Company issued to NMM the Restated NMM Note to amend, restate and replace the NMM Note, and the entire outstanding principal balance of the NMM Note, all accrued and unpaid interest thereon, and all other applicable fees, costs and charges, if any, shall be rolled into and become payable pursuant to the Restated NMM Note. The Restated NMM Note also extended the maturity date to the earlier of (A) March 31, 2019 or (B) 12 months after the date the Merger Agreement is terminated. Within 10 business days prior to maturity, NMM shall have the right (but not the obligation) in its sole discretion to convert the Restated NMM Note into shares of Common Stock at a conversion price of $10.00 per share (subject to adjustment for stock splits, dividends, recapitalizations and the like). In addition, pursuant to its terms, the principal amount of the Restated NMM Note shall be increased to $13,990,000 if the Company fails to pay the Amended Alliance Note described below, and NMM will either pay all amounts owed under the Amended Alliance Note or enter into another agreement with Alliance (such that in either case the Amended Alliance Note is cancelled). See Note 7 “Debt - Restated NMM Note” above for additional information.

40

 

On October 16, 2017, the Company and Alliance Apex, LLC (“Alliance”) amended the Alliance Note to extend the maturity date such that the entire outstanding principal and all accrued and unpaid interest thereon, is due and payable on the earlier of (i) March 31, 2018 or (ii) the date on which the Merger Agreement is terminated, whichever occurs first (the “Alliance Maturity Date”). If the Merger has not been consummated on or before the Alliance Maturity Date, then the outstanding principal balance and interest will be due 45 days after the Alliance Maturity Date. On the business day following closing of the Merger on or before the Alliance Maturity Date, the principal amount of the amended Alliance Note, together with all accrued and unpaid interest thereon, will automatically be converted into shares of Common Stock, at a conversion price of $10.00 per share, subject to adjustment for stock splits, stock dividends, reclassifications and other similar recapitalization transactions. See Note 7 “Debt - Amended Alliance Note” above for addition information. Pursuant to the Restated NMM Note, the principal amount of the Restated NMM Note shall be increased to $13,990,000 if the Company fails to pay the Amended Alliance Note, and NMM will either pay all amounts owed under the Amended Alliance Note or enter into another agreement with Alliance (such that in either case the Amended Alliance Note is cancelled).

Effectiveness of Amended S-4 Registration Statement

On August 11, 2017, NMM and ApolloMed filed a registration statement on Form S-4 with the SEC in connection with the proposed Merger. On October 30, 2017 and November 9, 2017, respectively, NMM and ApolloMed filed an Amendment No. 1 on Form S-4/A and two additional amendments, Amendment No. 2 and Amendment No. 3 on Forms S-4/A, to the August 11, 2017 registration statement. On November 13, 2017, the SEC staff declared the registration statement as amended to be effective.

 

ITEM 2.  MANAGEMENT’S DISCUSSION AND ANALYSIS OF FINANCIAL CONDITION AND RESULTS OF OPERATIONS

 

The following management’s discussion and analysis should be read in conjunction with the unaudited condensed consolidated financial statements and the notes thereto included in Part I, Item 1, “Financial Statements” of this Report.Quarterly Report on Form 10-Q. In addition, reference is made to our audited consolidated financial statements and notes thereto and related Management’s Discussion and Analysis of Financial Condition and Results of Operations included in our most recent Annual Report on Form 10-K for the year ended MarchDecember 31, 2017, filed with the U.S. Securities and Exchange Commission (“SEC”) on June 29, 2017.April 2, 2018.

 

In this Report, unless otherwise expressly stated or the context otherwise requires, the “Company,” “ApolloMed,” “we,” “us,” “our” and similar words refer to Apollo Medical Holdings, Inc., a Delaware corporation, its consolidated subsidiaries and its affiliates. Our affiliated professional organizations are separate legal entities that provide physician services and with which we have management service agreements. For financial reporting purposes, we consolidate the revenues and expenses of all our practice groups that we own or manage because we have a controlling financial interest in these practices based on applicable accounting rules and as described in our accompanying consolidated financial statements. References to “practices” or “practice groups” refer to our subsidiary-management company and the affiliated professional organizations of Apollo that provide medical services, unless otherwise expressly stated or the context otherwise requires.

27 

The following management’s discussion and analysis contain forward-looking statements that reflect our plans, estimates, and beliefs as discussed in the “Forward-Looking Statements” at the beginning of this Report.Quarterly Report on Form 10-Q. Our actual results could differ materially from those plans, estimates, and beliefs. Factors that could cause or contribute to these differences include those discussed below and elsewhere in this Quarterly Report on Form 10-Q as well as the factors discussed in Part I, Item 1A, “Risk Factors” in our most recent Annual Report on Form 10-K for the year ended MarchDecember 31, 2017.

Overview

 

We, together with our affiliated physician groups and consolidated entities, are a patient-centered, physician-centric integrated population health management company working to provideproviding coordinated, outcomes-based medical care in a cost-effective manner. Led by a management team with over a decade of experience, we have built a companymanner and culture that is focused on physicians providing high-quality medical care, population health management and care coordination for patients, particularly senior patients and patients with multiple chronic conditions. We believe that we are well-positioned to take advantage of changes in the rapidly evolving U.S. healthcare industry, as there is a growing national movement towards more results-oriented healthcare centered on the triple aim of patient satisfaction, high-quality care and cost efficiency. Our three core pillars are: our clinical expertise in managing patients with multiple chronic conditions, our experience in taking on financial risk for these patients, and our technology infrastructure.

We implement and operate innovative health care models to create a patient-centered, physician-centric experience. We have the following integrated, synergistic operations:

·Hospitalists, which includes our contracted physicians who focus on the delivery of comprehensive medical care to hospitalized patients;

·An accountable care organization (“ACO”) participating in the Medicare Shared Savings Program (the “MSSP”), which focuses on providing high-quality and cost-efficient care to Medicare fee-for-service (“FFS”) patients;

·A next generation accountable care organization (“NGACO”), which started operations on January 1, 2017, and focuses on providing high-quality and cost-efficient care for Medicare FFS patients;

·An independent practice association (“IPA”), which contracts with physicians and provides care to Medicare, Medicaid, commercial and dual-eligible patients on a risk- and value-based fee basis;

·One clinic which we own, and which provides specialty care in the greater Los Angeles area;

·Hospice care, Palliative care, and home health services, which include our at-home and end-of-life services; and

·A cloud-based population health management IT platform, which was acquired in January 2016, and includes digital care plans, a case management module, connectivity with multiple healthcare tracking devices and also integrates clinical data.

We operate in one reportable segment, the healthcare delivery segment. Our revenue streams are diversified among our various operations and contract types, and include:

·Traditional FFS reimbursement; and

·Risk and value-based contracts with health plans, third party IPAs, hospitals and the NGACO and MSSP sponsored by CMS, which are the primary revenue sources for our hospitalists, ACOs, IPAs and hospice/palliative care operations.

We serve Medicare, Medicaid, HMO and uninsuredserving patients in California. We provide services to patients,California, the majority of whom are covered by private or public insurance provided through Medicare, Medicaid and health maintenance organizations (“HMOs”), with a small portion of our revenue coming from non-insured patients. We provide care coordination services to each major constituent of the healthcare delivery system, including patients, families, primary care physicians, specialists, acute care hospitals, alternative sites of inpatient care, physician groups and health plans. Our physician network consists of primary care physicians, specialist physicians and hospitalists. We operate primarily through Apollo Medical Holdings, Inc. (“ApolloMed”) and the following subsidiaries: Network Medical Management (“NMM”), Apollo Medical Management, Inc. (“AMM”), APA ACO, Inc. (“APAACO”) and Apollo Care Connect, Inc. (“Apollo Care Connect”), and their consolidated entities, including consolidated VIEs.

 

Our missionLed by a management team with over a decade of experience, we have built a company and culture that is focused on physicians providing high-quality medical care, population health management and care coordination for patients. We believe that we are well-positioned to transformtake advantage of the delivery of healthcare servicesgrowing trends in the communitiesU.S. healthcare industry towards value-based and results-oriented healthcare focusing on the triple aim of patient satisfaction, high-quality care and cost efficiency.

Through our next generation accountable organization (“NGACO”) model and a network of independent practice associations (“IPAs”) with more than 4,000 contracted physicians, which physical groups have agreements with various health plans, hospitals and other HMOs, we serve by implementing innovative populationare currently responsible for coordinating the care for over one million patients in California. These covered patients are comprised of managed care members whose health modelscoverage is provided through their employers or who have acquired health coverage directly from a health plan or as a result of their eligibility for Medicaid or Medicare benefits. Our managed patients benefit from an integrated approach that places physicians at the center of patient care and creatingutilizes sophisticated risk management techniques and clinical protocols to provide high-quality, cost effective care. To implement a patient-centered, physician-centric experience, we also have other integrated and synergistic operations, including (i) MSOs that provide management and other services to our affiliated IPAs, (ii) outpatient clinics and (iii) hospitalists that coordinate the care of patients in a high-performance environment of integrated care.hospitals.

Recent Developments

 

The initial business owned by us was ApolloMed Hospitalists (“AMH”), a hospitalist company, incorporated in California in June, 2001, which beganfollowing describes certain developments from 2017 to date that are important to understanding our overall results of operations at Glendale Memorial Hospital. Through a reverse merger, we became a publicly held company in June 2008.and financial condition.

 

We were initially organized around the admission and careConsummation of patients at inpatient facilities such as hospitals. We have grown our inpatient strategy in a competitive market by providing high-quality care and innovative solutions for our hospital and managed care clients.


We operate through our subsidiaries, including:

·Apollo Palliative Care Services, LLC (“APS”);
·Apollo Medical Management, Inc. (“AMM”)
·Pulmonary Critical Care Management, Inc. (“PCCM”)
·Verdugo Medical Management, Inc. (“VMM”); and
·ApolloMed Accountable Care Organization, Inc. (“ApolloMed ACO”).

We have a controlling interest in APS, which owns two Los Angeles-based companies, Best Choice Hospice Care LLC (“BCHC”) and Holistic Care Home Health Care Inc. (“HCHHA”). Our palliative care services focuses on providing relief from the symptoms and stress of a serious illness. The goal is to improve quality of life for both the patient and the patient’s family.Merger

 

AMM, PCCM and VMM each operates as a physician practice management company and isOn December 8, 2017, ApolloMed completed its business combination with NMM following the satisfaction or waiver of the conditions set forth in the businessAgreement and Plan of providing management services to physician practice corporations under long-term MSAs,Merger, dated as of December 21, 2016 (as amended on March 30, 2017 and October 17, 2017), among ApolloMed, Apollo Acquisition Corp. (“Merger Sub”), NMM and Kenneth Sim, as the shareholders’ representative (the “Merger Agreement”), pursuant to which AMM, PCCM or VMM,Merger Sub merged with and into NMM, with NMM surviving as applicable, manages certain non-medical servicesa wholly owned subsidiary of ApolloMed (the “Merger”). The combination of ApolloMed and NMM brings together two complementary healthcare organizations to form one of the nation’s largest integrated population health management companies. As a result of the Merger, NMM now is a wholly-owned subsidiary of ApolloMed and former NMM shareholders own a majority of the issued and outstanding common stock of ApolloMed. For accounting purposes, the Merger is treated as a “reverse acquisition” and NMM is considered the accounting acquirer. Accordingly, as of the closing of the Merger, NMM’s historical results of operations replaced ApolloMed’s historical results of operations for periods prior to the physician groupMerger, and has exclusive authority over all non-medical decision making related to ongoing business operations. The MSAs that AMM, PCCM and VMM enter into with physician groups generally provide for management fees that are recognized as earned based on a percentage of revenues or cash collections generated by the physician practices.

Through PCCM we managed Los Angeles Lung Center (“LALC”), and through VMM we managed Eli Hendel, M.D., Inc. (“Hendel”). On January 1, 2017 and March 24, 2017, PCCM and VMM amended the MSAs entered into with LALC and Hendel, respectively, and among other things, reduced the scope of services to be provided by PCCM and VMM to align with the actual course of dealing between the parties. Based on our evaluation of current accounting guidance, we determined that we no longer hold an explicit or implicit variable interest in these entities. We have consolidated the results of these entities through December 31, 2016.operations of both companies are included in the accompanying condensed consolidated financial statements for periods following the Merger.

  

Through AMM, we manage a number of our affiliates pursuant to their long-term MSAs with AMM, including:

41

 

·AMH, the initial business owned by us;
·Maverick Medical Group, Inc. (“MMG”);
·Southern California Heart Centers (“SCHC”); and
·Bay Area Hospitalist Associates, a Medical Corporation (“BAHA”).

 

In 2012, we formedconnection with the Merger, ApolloMed issued an ACO,aggregate of 27,357,605 shares of its common stock to the former stockholders of NMM (ApolloMed held back an aggregate of 3,039,609 shares of its common stock, or 10% of the total number of shares issued to former NMM stockholders, to secure NMM’s potential indemnification obligations under the Merger Agreement). Accordingly, immediately following the Merger, ApolloMed’s stockholders prior to the Merger continued to hold 6,109,205 shares of its common stock, and the former NMM stockholders held 27,357,605 shares (excluding the 10% hold-back). In connection with the Merger, ApolloMed ACO, which participatesalso issued to the former NMM stockholders (i) common stock warrants to purchase 850,000 shares of ApolloMed’s common stock, exercisable at $11.00 per share, and (ii) common stock warrants to purchase 900,000 shares of common stock, exercisable at $10.00 per share. ApolloMed had previously issued a convertible promissory note (the “Alliance Note”) to Alliance Apex, LLC in the MSSPprincipal amount of $4,990,000. Following the Merger, the Alliance Note and accrued interest automatically converted into 520,081 shares of ApolloMed’s common stock. The former NMM stockholders also own Series A and Series B warrants to improvepurchase an aggregate of 1,111,111 shares and 555,555 shares of ApolloMed’s common stock, respectively. Under the qualityAgreement and Plan of patient careMerger, ApolloMed also agreed to indemnify the former NMM Shareholders under certain circumstances. If these indemnification obligations are triggered, ApolloMed will be required to issue up to 3,039,609 shares of ApolloMed common stock to the former NMM stockholders on a pro rata basis based on their relative proportionate pre-Merger ownership interests in NMM. Following the Merger, NMM, as ApolloMed’s subsidiary, continues to hold 1,111,111 shares of ApolloMed’s Series A preferred stock and outcomes through more efficient and coordinated approach among providers, and an IPA, MMG. In 2013 we expanded our service offering555,555 shares of ApolloMed’s Series B preferred stock, which shares are considered to include integrated inpatient and outpatient services through MMG.be issued but not outstanding.

 

In 2014,Post-Merger Integration

Following the closing of the Merger, we added several complementaryevaluated the sustainability of our subsidiaries and VIEs and opportunities to strengthen our operations. As a result of such evaluation, we decided to consolidate our operations by acquiring an IPA, AKM Medical Group, Inc. (“AKM”), outpatient primary care and specialty clinics, as well as hospice/palliative care and home health entities. During fiscal year 2016, we combinedrestructure the operations of AKM into thosecertain entities, including winding down the Bay Area Hospitalist Associates.

Conversion to NGACO

We operated three MSSP ACOs, AP-ACO, APCN-ACO and Apollo-ACO. Following the establishment of MMG.

In 2014, we acquired SCHC, a specialty clinic that focuses on cardiac careAPAACO, our NGACO, and diagnostic testing.

In 2016, we acquired a controlling interest in BAHA. BAHA is a hospitalist, intensivist and post-acute care practice with a presence at three acute care hospitals, one long-term acute care hospital and several skilled nursing facilities in San Francisco.

In 2016, we, together with NMM, formed APA ACO, Inc. (“APAACO”)the selection of APAACO by CMS to participate in the NGACO Model, for which we were approved by CMS in January 2017. The goal of the NGACO Model is to improve the quality of patient care and outcomes through more efficient and coordinated approach among providers.

Our physician network consists of hospitalists, primary carehave converted physicians and specialist physicians primarily throughpatients from our ownedMSSP ACOs to our NGACO. As providers continue to enroll in our NGACO and affiliated physician groups. On February 17, 2015,their patients become beneficiaries under our NGACO, we entered into a long-term management services agreement (the “Bay Area MSA”) with a hospitalist group located inhave transitioned the San Francisco Bay Area. Under the Bay Area MSA, we provide certain business administrative services, including accounting, human resources management and supervision of non-medical businessthree MSSP ACOs’ operations. We evaluated the Bay Area MSA and have determined that it triggers variable interest entity accounting, which requires consolidating the hospitalist group into our consolidated financial statements. During fiscal year 2017, we entered into four management services agreements with various hospitalsTo position ourselves to provide staffing.

In 2016, through Apollo Care Connect, we acquired certain technology and other assets of Healarium, Inc., which provides us with a population health management platform that includes digital care plans, a case management module, connectivity with multiple healthcare tracking devices and the ability to integrate with multiple electronic health records to capture clinical data.

Our common stock (“Common Stock”) is currently quoted on OTC Pink and traded under the symbol “AMEH.” ApolloMed has applied for listing of its common stock on the NASDAQ Global Market effective as of the closing of the Merger. No assurance can be given that we can meet the listing requirements for the NASDAQ Global Market, including at the closing of the Merger, or that ApolloMed’s application will ever be approved.


Recent Developments

Operations and Financings

For the three-month period ended September 30, 2017, we achieved a 177% increase in revenue over the same period in the prior fiscal year. This increase of approximately $27.9 million in revenue primarily resulted from the new APAACO NGACO contract with CMS that went into effect in April 2017. We also accrued approximately $27.3 million in costs related to this contract with CMS. Notwithstanding that revenue growth, our net loss without taking into account any non-controlling interest increased by approximately 188% during the same period mostly attributable to the proposed merger related cost.

In a continued effort to improve profitability, we terminated four hospitalist contracts during the six-month period ended September 30, 2017, ceased using locum tenens physicians starting in September 2017, and began several other operational efficiency initiatives.

APAACO (Next Generation ACO)

On January 18, 2017, CMS announced that APAACO, jointly owned by us and NMM, has been approved to participate in the new NGACO Model. Through the NGACO Model, CMS has partnered with APAACO and other ACOs experienced in coordinating care for populations of patients and whose provider groups are willing to assume higher levels of financial risk and reward under the NGACO Model. The NGACO program began on January 1, 2017. In connection with the approval by CMS for APAACO to participate in the NGACO Model, CMS and APAACO have entered into a NGACO Model Participation Agreement (the “Participation Agreement”). The term of the Participation Agreement is two performance years, from January 1, 2017 through December 31, 2018. CMS may offer to renew the Participation Agreement for an additional term of two performance years. Additionally, the Participation Agreement may be terminated sooner by CMS as specified therein.

AMM, one of our wholly-owned subsidiaries, has a long-term management services agreement with APAACO. APAACO is a consolidating variable interest entity of AMM as it was determined that AMM is the primary beneficiary of APAACO.

To participate in the NGACO Model, we have devoted, and intend to continue to devote, significant effort and resources, financial and otherwise, to the NGACO Model, and refocused away and pulled resources from certain other parts of our historic business and revenue streams, including the MSSP ACO, which will receive less emphasis in the future and could result in reduced revenue from such business.these activities. Our NGACO currently is eligible for receiving monthly AIPBP payments at a rate of approximately $7.3 million per month from CMS. We currently anticipate that revenue from the NGACO Model if successful, will be a significant source of revenue for us in fiscal year 2018 and future periods, although no assurance of that can be given at this time. APAACO chose to participate in the All-Inclusive Population-Based Payment (“AIPBP”) payment mechanism of the NGACO Model. Under the AIPBP payment mechanism, CMS estimates the total annual Part A and Part B Medicare expenditures of APAACO’s assigned Medicare beneficiaries and pays that projected amount in per beneficiary per month payments. See Notes 1 and 2 to the accompanying condensed consolidated financial statements for additional information. APAACO’s futureAP-ACO terminated its participation in the AIPBP payment mechanism, however, is uncertain. In October 2017, CMS notified APAACO that it has not been renewed forMSSP effective as of December 31, 2016, and APCN-ACO and Apollo-ACO terminated their participation in the AIPBP payment mechanismMSSP effective as of the NGACO Model for performance year 2018 due to certain alleged deficiencies in performance by APAACO. APAACO does not believe the allegations by CMS of performance deficiencies are valid or justify the CMS non-renewal determination and is in discussions with CMS regarding possible reversal of such determination. On November 9, 2017, APAACO submitted a request for reconsideration to CMS. If APAACO is not successful in convincing CMS to reverse its decision then the payment mechanism under the NGACO Model would default to traditional Fee For Service (“FFS”). This would result in the loss in monthly revenues and cash flow currently being generated by APAACO, currently at a rate of approximately $9.3 million per month, and would thus have a material adverse effect on ApolloMed’s future revenues and potential cash flow.December 31, 2017.


Standby Letters of CreditStrategic Transactions

 

On March 3,Effective December 1, 2017, APAACO established an irrevocable standby letter of credit with a financial institution for $6,699,329 for the benefit of CMS. The letter of credit expires on December 31, 2017 and deemed automatically extended without amendment for additional one - year periods from the present or any future expiration date, unless notified by the institution to terminate prior to 90 days from any expiration date.

Proposed Merger

On December 21, 2016, we entered into an Agreement and Plan of Merger (the “Merger Agreement”) among us, Apollo Acquisition Corp., a wholly-owned subsidiary of ours (“Merger Subsidiary”), NMM and Kenneth Sim, M.D., in his capacity as the representative of the shareholders of NMM, pursuant to which NMM will merge into Merger Subsidiary (the “Merger”) and upon consummation of the Merger, NMM shareholders will receive such number of shares of Common Stock such that, after giving effect to the Merger and assuming there would be no dissenting NMM shareholders at the closing, NMM shareholders will own 82% of the total issued and outstanding shares of Common Stock at the closing of the Merger and our current stockholders will own the other 18% (the “Exchange Ratio”). Additionally, NMM has agreed to relinquish its redemption rights relating to our Series A Preferred Stock that NMM owns.

On March 30, 2017, NMM and ApolloMed, together with other relevant parties, entered into an Amendment to the Merger Agreement (the “Merger Agreement Amendment No. 1”) to exclude, for purposes of calculating the Exchange Ratio, from “parent shares” (as defined in the Merger Agreement) 499,000 shares of Common Stock issued or issuable pursuant to a securities purchase agreement dated as of March 30, 2017, between ApolloMed and Alliance Apex, LLC. As part the Merger Agreement Amendment No. 1, the merger consideration to be paid by the Company to NMM shareholders at the closing of the Merger was amended to include warrants to purchase 850,000 shares of Common Stock at an exercise price of $11 per share.

On October 17, 2017, NMM and ApolloMed entered into a second Amendment to the Mergerten-year Management Services Agreement (the “Merger Agreement Amendment No. 2”(“MSA”), which extended the “End Date” as defined in the Merger Agreement from August 31, 2017 to March 31, 2018, and increased NMM shareholders’ merger consideration payable at the closing of the Merger to include an aggregate of 2,566,666 shares of Common Stock and warrants to purchase an aggregate of 900,000 shares of Common Stock exercisable at $10.00 per share, in addition to such number of shares of Common Stock that represents 82% of the total issued and outstanding shares of Common Stock immediately following the consummation of the Merger and warrants to purchase 850,000 shares of Common Stock at an exercise price of $11 per share. Pursuant to the Merger Agreement Amendment No. 2, NMM also agreed to provide an additional $4,000,000 working capital loan to the Company as evidenced by a promissory note in the principal amount of $9,000,000 (the “Restated NMM Note”), which is convertible into shares of Common Stock at a conversion price of $10.00 per share (subject to adjustment for stock splits, dividends, recapitalizations and the like) within 10 business days prior to maturity. The Restated NMM Note amended and restated the previous $5,000,000 promissory note issued by the Company to NMM on January 3, 2017. In addition, pursuant to its terms, the principal amount of the Restated NMM Note shall be increased to $13,990,000 if the Company fails to pay the Amended Alliance Note described below, and NMM will either pay all amounts owed under the Amended Alliance Note or enter into another agreement with Alliance (such that in either case the Amended Alliance Note is cancelled).

On October 16, 2017, the Company and Alliance Apex, LLCAccountable Health Care IPA (“Alliance”) amended the Alliance Note to extend the maturity date for the entire outstanding principal and all accrued and unpaid interest thereon to the earlier of (i) March 31, 2018 or (ii) the date on which the Merger Agreement is terminated, whichever occurs first (the “Alliance Maturity Date”Accountable IPA”). If the Merger has not been consummated by the Alliance Maturity Date, then the outstanding principal balance and interest will be due 45 days after the Alliance Maturity Date. Pursuant to the Restated NMM Note, the principal amount of the Restated NMM Note shall be increased to $13,990,000 if the Company fails to pay the Amended Alliance Note, and NMM will either pay all amounts owed under the Amended Alliance Note or enter into another agreement with Alliance (such that in either case the Amended Alliance Note is cancelled). On the business day following closing of the Merger on or before the Alliance Maturity Date, the principal amount of the amended Alliance Note, together with all accrued and unpaid interest thereon, will automatically be converted into shares of Common Stock, at a conversion price of $10.00 per share, subject to adjustment for stock splits, stock dividends, reclassifications and other similar recapitalization transactions. The amended Alliance Note may not be prepaid, in whole or in part, by ApolloMed nor converted into shares of Common Stock voluntarily by Alliance.

NMMAccountable IPA is one of the largest healthcare management services organizationsIPAs in the United States, delivering comprehensiveCalifornia and currently provides quality healthcare management services to a client base consisting of health plans, IPAs, hospitals, physicians and other health care networks. NMM currently is responsible for coordinating the care for over 600,000 covered patients in Southern and Central California through a network of ten IPAs with over 2,000 contracted physicians. On a pro forma basis, the combined organization is expected to provide medical management for over 700,000more than 160,000 patients through a network of over 3,000 healthcare professionals450 primary care physicians and over 400 employees. The combination of ApolloMed1,700 specialty care physicians and NMM would bring together two complementary healthcare organizationshas multiple product lines, including Medicare Advantage, Commercial and Medi-Cal managed care. Pursuant to form onethe terms of the nation’s largest integratedten-year MSA, NMM is responsible for managing all health plan members assigned or delegated to Accountable IPA, as well as all hospital risk pools. This effort is expected to be supported by our population health management companies,platform, which we believe willincludes administrative, clinical and technology capabilities. One of our VIEs has extended a line of credit of up to $18 million to George M. Jayatilaka, M.D. a shareholder of Accountable IPA, to fund the working capital needs of Accountable IPA. The VIE has the right, but not the obligation, to convert a portion or all of the outstanding principal amount into shares of Accountable IPA’s capital stock. Concurrent with the funding, the board of directors of Accountable IPA was reconstituted to be well positioned for the ongoing transitioncomprised of U.S. healthcare to value-based reimbursements. The Merger, if consummated, is expected to further expandtwo directors, including one director appointed by one of our operating platform for providing high-quality, cost effective valued-based care.VIEs APC-LSMA.

 

The waiting periodNMM entered into a MSA with Joseph M. Molina, M.D., Professional Corporation – Southern California dba Golden Shore Medical Group, a California professional corporation (“GSMG”). GSMG currently provides healthcare services to more than 100,000 patients and operates 17 clinics in four California counties. NMM is entitled to receive management fees under the Hart-Scott-Rodino Antitrust Improvements ActMSA. The initial term of 1976, as amended (“HSR”), with respect to the proposed Merger expiredMSA commenced on July 7, 2017.January 1, 2018 and will expire on December 31, 2020. The MSA may be extended at the option of GSMG for an additional two-year term following the expiration of the HSR waiting period satisfies a condition to the closing of Merger. Based on current information and subject to future events and circumstances, consummation of the Merger, which remains subject to other conditions described in the Merger Agreement, including approval by ApolloMed’s stockholders and the shareholders of NMM, is expected to take place in the second half of calendar year 2017.initial term.

 

42

On August 11, 2017, NMM and ApolloMed filed a registration statement on Form S-4 with the Securities and Exchange Commission (the “SEC”) in connection with the proposed Merger. On October 30, 2017 and November 9, 2017, respectively, NMM and ApolloMed filed an Amendment No. 1 on Form S-4/A and two additional amendments, Amendment No. 2 and Amendment No. 3 on Forms S-4/A, to the August 11, 2017 registration statement.On November 13, 2017, the SEC staff declared the Form S-4 registration statement as amended to be effective.

 

We have appliedexpanded our operations, including hiring a significant number of employees and engaging other personnel, in preparation of serving additional patients that we are responsible for listing of Common Stock onmanaging under the NASDAQ Global Market effective as of the closing of the Merger. In September 2017, The Nasdaq Stock Market LLC (“Nasdaq”) requested us to provide additional information in relation to such application. We responded to Nasdaq’s request on November 3, 2017. No assurance can be given that our application will be approved after such response.Accountable IPA and GSMG MSAs.

 

For all purposes of this report, unless expressly indicated otherwise, we have discussed our present and intended operations, opportunities and challenges without consideration of the Merger or the effect of the Merger, if and should it be consummated.


The items above describe certain recent developments that are important to understanding our financial condition and results of operations. See the notes to our condensed consolidated financial statements included in this Report for additional information about these developments.

Results of Operations

The results of operations for the three and six months ended September 30, 2017 reflected a significant financial impact from our investments in population health management infrastructure and value-based care processes for our patients.

The following sets forth selected data from our results of operations for the periods presented:

  For the Six Months Ended
September 30,
  For the Three Months Ended
September 30,
 
  2017  2016  $
Change
  %
Change
  2017  2016  $
Change
  %
Change
 
                         
Net revenues $82,058,826  $26,994,329  $55,064,497   204% $40,483,346  $14,622,656  $25,860,690   177%
                                 
Costs and expenses                                
Cost of services  79,336,260   22,304,188   57,032,072   256%  39,096,618   12,171,183   26,925,435   221%
General and administrative  10,234,926   8,291,804   1,943,122   23%  5,345,742   4,455,329   890,413   20%
Depreciation and amortization  311,204   335,213   (24,009)  -7%  155,937   170,555   (14,618)  -9%
Total costs and expenses  89,882,390   30,931,205   58,951,185   191%  44,598,297   16,797,067   27,801,230   166%
                                 
Loss from operations  (7,823,564)  (3,936,876)  (3,886,688)  99%  (4,114,951)  (2,174,411)  (1,940,540)  89%
                                 
Other (expense) income:                                
Interest expense  (392,651)  (5,713)  (386,938)  6773%  (199,662)  (3,054)  (196,608)  6438%
Gain on change in fair value of warrant liability  -   1,333,333   (1,333,333)  -100%  -   511,111   (511,111)  -100%
 Other income  93,295   12,531   80,764   645%  54,635   10,560   44,075   417%
Total other income (expense), net  (299,356)  1,340,151   (1,639,507)  -122%  (145,027)  518,617   (663,644)  -128%
                                 
Loss before benefit from income taxes  (8,122,920)  (2,596,725)  (5,526,195)  213%  (4,259,978)  (1,655,794)  (2,604,184)  157%
                                 
Benefit from income taxes  (56,692)  (226,593)  169,901   -75%  (26,858)  (185,040)  158,182   -85%
                                 
Net loss $(8,066,228) $(2,370,132) $(5,696,096)  240% $(4,233,120) $(1,470,754) $(2,762,366)  188%
                                 
Net loss (income) attributable to noncontrolling interest  571,624   (303,534)  875,158   -288%  350,382   112,345   238,037   212%
                                 
Net loss attributable to Apollo Medical Holdings, Inc. $(7,494,604) $(2,673,666) $(4,820,938)  180% $(3,882,738) $(1,358,409) $(2,524,329)  186%

Three and Six Months Ended September 30, 2017 Compared to Three and six Months Ended September 30, 2016

Net revenues

Net revenues for the three months ended September 30, 2017 increased by approximately $25.9 million, or 177%, as comparedSixth Amendment to the same period of 2016. The increase in net revenues was primarily due to an increase of approximately $27.9 million in APAACO’s revenues resulting from the new NGACO contract with CMS, pursuant to which we started to receive capitation from CMS in April 2017, an increase of approximately $0.4 million in AMH’s revenues which resulted from hospitalist contracts that started in the second quarter of fiscal year 2017. These increases were partially offset by a decrease of $0.5 million in MMG’s revenues, which resulted from a deficit in the full risk contracts related to high patient care cost, a decrease of approximately $0.4 million in BAHA’s revenues related to a decrease in patient encounters and termination of a facility contract, a decrease of $0.1 million in SCHC’s revenues related to decreased patient encounters, a decrease of $0.3 million in BCHC’s revenues due to decreased patient census, a decrease of $0.5 million in HCHHA’s revenues due to decreased patient census, as well as a decrease of $0.6 million in revenues of LALC and Hendel due to deconsolidation of the two variable interest entities (“VIEs”) from us during the fourth quarter of fiscal year 2017.

Net revenues for the six months ended September 30, 2017 increased by approximately $55.1 million, or 204%, as compared to the same period of 2016. The increase in net revenues was primarily due to an increase of approximately $55.7 million in APAACO’s revenues resulting from the new NGACO contract with CMS, pursuant to which we started to receive capitation from CMS in April 2017, an increase of approximately $2.9 million in AMH’s revenues which resulted from the new hospitalist contracts that started in the second quarter of fiscal year 2017. These increases were partially offset by a decrease of $0.8 million in MMG’s revenues, which resulted from a deficit in the full risk contracts related to high patient care cost, a decrease of $0.9 million in BCHC’s revenues due to decreased patient census, a decrease of $0.6 million in HCHHA’s revenues due to decreased patient census, as well as a decrease of $1.1 million in revenues of LALC and Hendel due to deconsolidation of the two variable interest entities (“VIEs”) from us during the fourth quarter of fiscal year 2017. The Company’s other entities accounted for an aggregate decrease of $0.1 million, none of which were individually significant.


Cost of services

Cost of services for the three months ended September 30, 2017 increased by approximately 26.9 million, or 221%, as compared to the same period of 2016. The increase in cost of services was primarily related to an increase of approximately $27.3 million in APAACO expenses related to the patient care, a decrease of approximately $0.4 million in AMH’s and BAHA’s expenses related to migration from the use of contracted providers to employed providers, and an increase of approximately $0.6 million in MMG’s expenses due to increased costs in patient care. These expenses were partially offset by a decrease of approximately $0.1 million and a decrease of $0.2 million in BCHC’s expenses and HCHHA’s expenses, respectively, both of which were due to reduction in patient census, as well as a decrease of approximately $0.1 million in each of LALC’s expenses and Hendel’s expenses, respectively, both of which were due to deconsolidation of the two VIEs from us during the fourth quarter of fiscal year 2017 and a decrease of $0.1 million in SCHC’s expenses.

Cost of services for the six months ended September 30, 2017 increased by approximately $57.0 million, or 256%, as compared to the same period of 2016. The increase in cost of services was primarily related to an increase of approximately $54.6 million in APAACO expenses related to the patient care, an increase of approximately $2.2 million in AMH’s expenses related to the new hospitalist contracts that increased AMH’s revenues, an increase of approximately $0.9 million in BAHA’s expenses related to its new hospitalist contract and the use of locum providers, and an increase of approximately $0.8 million in MMG’s expenses due to increased costs in patient care. These increases in expenses were partially offset by a decrease of approximately $0.4 million and a decrease of $0.4 million in BCHC’s expenses and HCHHA’s expenses, respectively, both of which were due to reduction in patient census, as well as a decrease of an aggregate of approximately $0.5 million in LALC’s and Hendel’s expenses, both of which were due to deconsolidation of the two VIEs from us during the fourth quarter of fiscal year 2017 and a decrease of approximately $0.2 million in SCHC’s expenses.

General and administrative

General and administrative (G&A) costs for the three months ended September 30, 2017 increased by approximately $0.9 million, or 20%, as compared to the same period of 2016. Approximately $0.9 million of the increase was due to APAACO’s new NGACO operations, approximately $0.7 million of the increase was related to costs associated with the proposed Merger with NMM, and approximately $0.2 million correlated to an increase in MMG’s G&A costs. These increases in our G&A costs were offset by a decrease of approximately $0.4 million in ACO’s G&A costs as the MMSP ACO operations have been gradually merged into the NGACO program of APAACO, a decrease of approximately $0.3 million related to AMH from general management of overhead costs, and a decrease of approximately $0.2 million in Hendel’s G&A costs due to its deconsolidation from us during the fourth quarter of fiscal year 2017.

G&A costs for the six months ended September 30, 2017 increased by approximately $1.9 million, or 23%, as compared to the same period of 2016. Approximately 1.7 million of the increase was due to APAACO’s new NGACO operations, approximately $1.3 million of the increase was related to costs associated with the proposed Merger with NMM, and approximately $0.1 million of the increase correlated to an increase in MMG’s G&A costs. These increases in our G&A costs were offset by a decrease of approximately $0.8 million in ACO’s G&A costs as the MMSP ACO operations have been gradually merged into the NGACO program, a decrease of approximately $0.3 million in AMH expenses related to general management of overhead costs, and a decrease of approximately $0.1 million in Hendel’s G&A costs due to its deconsolidation from us during the fourth quarter of fiscal year 2017.

Depreciation and amortization

Depreciation and amortization during the three and six months ended September 30, 2017 were comparable to the same periods of fiscal year 2016.

Interest expense

Interest expense increased by approximately $0.2 million and $0.4 million, or 6,438% and 6,773% during the three and six months ended September 30, 2017, as compared to the same periods of 2016, respectively. The increase in interest expense is due to the addition of the $5,000,000 NMM Note and $4,990,000 Alliance Note. See Note 7 “Debt” to the accompanying condensed consolidated financial statements for additional information.

Gain on change in fair value of warrant liabilities

There was a gain on the change in fair value of the warrant liabilities of approximately $0.5 and $1.3 million for the three and six months ended September 30, 2016. This gain resulted from the change in the fair value measurement of the Company’s warrants issued to NMM in October 2015, which consider among other things, expected term, the volatility of the Company’s share price, interest rates, and the probability of additional financing. As there was no warrant liability at either March 31, 2017 or September 30, 2017, there is no change in the fair value of warrant liabilities for the three and six months ended September 30, 2017.

Other income

Other income increased by approximately $44,000 and $80,000, or 417% and 645%, for the three and six months ended September 30, 2017 compared to the same periods of 2016, respectively. The increase in other income is due to interest from the cash held by APAACO.


Income tax provision (benefit)

Benefit from income taxes was less in the current fiscal year periods comparable to the same periods of fiscal year 2016 because there are losses that receive no tax benefit as a result of a valuation allowance being recorded for such losses and the exclusion of loss entities from our overall estimated annual effective rate calculation.

Net loss attributable to non-controlling interests

Net loss attributable to non-controlling interests increased by approximately $0.2 million, or 212%, for the three months ended September 30, 2017 as compared to the same period of fiscal year 2016, which resulted from the deconsolidation of LALC and Hendel from us in the fourth quarter of fiscal year 2017.

Net loss attributable to non-controlling interests increased by approximately $0.9 million, or 288%, for the six months ended September 30, 2017, as compared to the same period of fiscal year 2016, which resulted from the deconsolidation of LALC and Hendel from us in the fourth quarter of fiscal year 2017.

Liquidity and Capital Resources

The accompanying condensed consolidated financial statements have been prepared assuming that we will continue as a going concern, which contemplates the realization of assets and settlement of liabilities in the normal course of business.

We have a history of operating losses. For the six months ended September 30, 2017 and 2016, we had a net loss of approximately $8.1 million and $2.4 million, respectively. We generated positive cash flow from operations of approximately $21.5 million for the six months ended September 30, 2017 and used cash in operating activities of approximately $4.4 million for the six months ended September 30, 2016. We do not expect to have positive cash flow from operations for the remainder of fiscal year 2018. Cash flows used in investing activities for the six months ended September 30, 2017 and 2016, were approximately $0.06 million and $0.2 million, respectively. Cash flows provided by financing activities for the six months ended September 30, 2017 was approximately $0.05 million, and Cash flows used by operation in 2016 was approximately $0.9 million.

As of September 30, 2017, we have a net working capital deficit of approximately $7.0 million and an accumulated deficit of approximately $45.1 million, net borrowings from notes and lines of credit totaling approximately $10.0 million and availability ty under lines of credit of approximately $0.1 million. The primary source of liquidity as of September 30, 2017 is cash and cash equivalents of approximately $30.2 million, which includes the capitation payments received from CMS, all or most of which will be used to pay the corresponding fee for service claims liability in future months.

These factors among others raise substantial doubt about our ability to continue as a going concern. Our long-term ability to continue as a going concern is dependent upon our ability to increase revenue, reduce costs, achieve a satisfactory level of profitable operations, and obtain additional sources of suitable and adequate financing.

Our ability to continue as a going concern is also dependent our ability to further develop our business. We may also have to reduce certain overhead costs through the reduction of salaries and other means, and settle liabilities through negotiation. There can be no assurance that management’s plan and attempts at any or all of these endeavors will be successful.

In addition, our ability to continue as a going concern depends, in significant part, on our ability to obtain the necessary financing to meet our obligations and pay our obligations arising from normal business operations as they come due. To date, we have funded our operations from a combination of internally generated cash flow and external sources, including the proceeds from the issuance of equity and/or debt securities. We expect to continue to fund our working capital requirements, capital expenditures and payments of principal and interest on outstanding indebtedness, with cash on hand, cash flows from operations, available borrowings under our lines of credit and, if available, additional financings of equity and/or debt by our current investors and/or others. Management does not believe that we have sufficient liquidity to meet our obligations for at least the next twelve months without some additional funds, such as funds available from raising capital. However, no assurance can be given that any such funds will be available at all or available on favorable terms.

We, therefore, are substantially dependent upon the consummation of the Merger to meet our liquidity requirements. See “The Proposed Merger and NMM Note” below. Until we can generate sufficient positive cash flow to fund operations, we will remain dependent on raising additional capital through debt and/or equity transactions. Without limiting our available options, future equity financings will most likely be through the sale of debt and/or equity securities. It is possible that we would also offer warrants, options and/or rights in conjunction with any future sales of our securities. Management believes that we will be able to raise additional working capital through the issuance of stock and/or debt. Currently, however, we do not have any commitments for the proposed Merger or additional capital, nor can we provide assurance that any financing will be available to us on favorable terms, or at all. If, after utilizing the existing sources of capital available to us, further capital needs are identified and we are not successful in obtaining financing, we may be forced to curtail our existing or planned future operations.


For the six months ended September 30, 2017, cash provided by operating activities was approximately $21.5 million. This was the result of a change in working capital of $28.7 million due to increases in accounts receivable, medical liabilities and add-backs of non-cash items of $0.9 million, net, offset by a net loss of approximately $8.1 million. For the six months ended September 30, 2017, our non-cash expenses primarily included provision for depreciation and amortization expense, stock-based compensation expense, and amortization of debt issuance costs.

For the six months ended September 30, 2017, cash used in investing activities was approximately $0.06 million primarily related to purchases of fixed assets.

For the six months ended September 30, 2017, net cash provided by financing activities was $0.05 million, which relates to proceeds from the exercise of warrants net of principal payments on the BAHA line of credit.

The unaudited condensed consolidated financial statements do not include any adjustments relating to the recoverability and classification of recorded assets, or the amounts and classification of liabilities that might be necessary in the event that we cannot continue as a going concern.

In connection with its liquidity and capital resources, below is a high-level summary of the Company’s major financing activities as well as related agreements, including (i) NNA financing, (ii) NMM investments, (iii) the proposed Merger and NMM Note, and (iv) the Alliance Note and MergerRegistration Rights Agreement Amendment No. 1, and (v) the Merger Agreement Amendment No. 2, Restated NMM Note and Amended Alliance Note. Our securities issued in connection in such financing activities have not been registered under the Securities Act of 1933, as amended.

NNA Financing

 

In March 2018, ApolloMed entered into a Sixth Amendment (the “Sixth Amendment”) of the Registration Rights Agreement, dated as of March 28, 2014, concurrently with a credit agreement (the “Credit Agreement”), an investment agreement (the “Investment Agreement”) with, a convertible note and stock purchase warrants issued to, NNA of Nevada, Inc. (“NNA”), an affiliate of Fresenius SE & Co. KGaA (“Fresenius”), we entered into a registration rights agreement (the “Registration Rights Agreement”) with NNA, pursuant toMedical Care North America. The Sixth Amendment extended (i) the deadline by which we are required to prepare andApolloMed must file a resale registration statement covering NNA’s registrable ApolloMed securities, and will have to issue additional shares of Common Stock to NNA if we fail to comply with such requirement.  

In October, 2015, we repaid the outstanding term loan and revolving credit facility under the Credit Agreement. In November, 2015, we issued a total of 600,000 shares of Common Stock and paid accrued and unpaid interest of $47,112 to NNA in exchange for the convertible note and all of the stock purchase warrants issued to NNA. We and NNA also extended the deadline for filing the resale registration statement covering NNA’s registrable securities as required under the Registration Rights Agreement and amended the Investment Agreement to (i) delete NNA’s right to subscribe to purchase a pro rata share of certain new equity securities that may be issued by us in the future, and (ii) provide that NNA must hold at least 200,000 shares of Common Stock to have the right to have a representative nominated as a member of the Company’s Board of Directors (the “Board”) and each committee thereof and appoint a representative to attend all Board and committee meetings in a nonvoting observer capacity. NNA nominated Mark Fawcett as its representative on the Board, who was first elected as our director on January 12, 2016.

In April and July 2017, we and NNA amended the Registration Rights Agreement to extend the deadline for filing the resale registration statement for NNA to March 31, 2018 and the date by which we arethe registration statement is required to usebe declared effective by the SEC. Under the Sixth Amendment, ApolloMed is now required file the registration statement by November 30, 2018 and, using its commercially reasonable best efforts, to cause suchthat registration statement to be declared effective to June 30, 2018 (or, if earlier, the 5th trading day after the date on which the Securities and Exchange Commission notifies us that such registration statement will not be “reviewed” or subject to further review), and remove prohibitions on the Company’s ability to file other registration statements.May 31, 2019.

 

NMM Investments

On October 14, 2015, we entered into a Securities Purchase AgreementCompliance with NMM, pursuant to which we sold 1,111,111 units (the “Series A Units”), each Series A Unit consisting of one share of our Series A Preferred Stock (the “Series A Preferred Stock”) and a stock purchase warrant (the “Series A Warrant”) to purchase one share of Common Stock at an exercise price of $9.00 per share, for which NMM paid us $10,000,000. We used the proceeds to repay certain outstanding indebtedness owed by us to NNA under the Credit Agreement. The Series A Units initially had a redemption feature. However, as part of the proposed Merger, NMM entered into a Consent and Waiver Agreement dated December 21, 2016, pursuant to which NMM has relinquished its right of redemption with respect to its shares of Series A Preferred Stock and Series A Warrants. On March 30, 2016, we entered into a Securities Purchase Agreement with NMM, pursuant to which we sold NMM 555,555 units (the “Series B Units”) each Series B Unit consisting of one share of our Series B Preferred Stock (the “Series B Preferred Stock”) and a stock purchase warrant (the “Series B Warrant”) to purchase one share of Common Stock at an exercise price of $10.00 per share, for which NMM paid us $4,999,995 which was be used for our working capital. See Note 6 to the accompanying condensed consolidated financial statements for additional information on Series A Preferred Stock, Series A Warrant, Series B Preferred Stock and Series B Warrant.

The Proposed Merger and NMM Note

On December 21, 2016, we entered into the Merger Agreement with NMM. Under the terms of the Merger Agreement, Apollo Acquisition Corp., a wholly-owned subsidiary of the Company (“Merger Subsidiary”), will merge with and into NMM, with NMM becoming one of our wholly-owned subsidiaries and NMM shareholders will own 82% of the total issued and outstanding shares of Common Stock at the closing of the Merger and our current stockholders will own the other 18% (the “Exchange Ratio”). The Merger is intended to qualify for federal income tax purposes as a tax-deferred reorganization under the provisions of Section 368(a) of the Internal Revenue Code of 1986. Consummation of the Merger is subject to various closing conditions, including, among other things, approval by the stockholders of the Company and the shareholders of NMM. The Merger Agreement also provides that Thomas Lam, M.D., current Chief Executive Officer of NMM, and Warren Hosseinion, M.D., will be Co-Chief Executive Officers of the combined company upon closing of the Merger. Kenneth Sim, M.D., who currently serves as Chairman of NMM, will be Executive Chairman of the combined company. Gary Augusta, current Executive Chairman of the Company, will be President, Mihir Shah will continue as Chief Financial Officer, and Hing Ang, current Chief Financial Officer of NMM will be the Chief Operating Officer. Adrian Vazquez, M.D. and Albert Young, M.D. will be Co-Chief Medical Officers. The Board of Directors of the combined company will consist of nine directors, five appointees (including three independent directors) from NMM and four appointees (including two independent directors) from the Company. Thomas Lam, M.D., who is also one of our directors, and Kenneth Sim, M.D. entered into voting agreement (the “Voting Agreements”) with us. Under the Voting Agreements, Dr. Sim and Dr. Lam have agreed, among other things, to vote in favor of the approval and adoption of the Merger and the Merger Agreement.


As required by the terms of the Merger Agreement, on January 3, 2017, NMM provided a working capital loan to us, which was evidenced by a promissory note in the principal amount of $5,000,000 (the “NMM Note”).

We currently anticipate the closing of the Merger to take place in the second half of calendar year 2017, which remains subject to conditions described in the Merger Agreement. However, if the Merger Agreement is terminated and the Merger is not consummated, we might have an immediate need to raise additional capital to fund our business and meet our expenses, including both transactional and operational expenses.

Alliance Note and Merger Agreement Amendment No. 1

On March 30, 2017, Alliance APEX, LLC (“Alliance”) loaned us $4,990,000, and for which we issued the Alliance Note bearing interest at a rate of 6% per annum. The Alliance Note is due and payable to Alliance on (i) December 31, 2017, or (ii) the date on which the Merger Agreement is terminated, whichever occurs first.

We have granted Alliance both “demand” and “piggyback” registration rights to register the shares of Common Stock issuable upon conversion of the Alliance Note, subject to a good faith, pro rata claw-back provision.

In connection with the Alliance Note, Alliance requested NMM to guaranty repayment of the Alliance Note if it is not converted into shares of Common Stock in accordance therewith. In connection with the issuance of such guaranty, we and NMM, together with other parties, entered into an Amendment to the Merger Agreement (the “Merger Agreement Amendment No. 1”). Pursuant to the Merger Agreement Amendment No. 1, certain shares of Common Stock, including shares issuable to Alliance upon conversion of the Alliance Note, are excluded from the “Parent Shares” (as defined in the Merger Agreement) for purposes of calculating the Exchange Ratio. Additionally, as consideration for excluding the shares issuable upon conversion of the Alliance Note from the Parent Shares and thus the calculation of Exchange Ratio and for NMM’s issuing the guaranty, we agreed to issue NMM shareholders warrants to purchase 850,000 shares of Common Stock at an exercise price of $11.00 per share, as part of the merger consideration, payable at the closing of the Merger.

Merger Agreement Amendment No. 2, Restated NMM Note and Amended Alliance Note

On October 17, 2017, we and NMM and ApolloMed entered into a second Amendment to the Merger Agreement (the “Merger Agreement Amendment No. 2”), which extended the “End Date” as defined in the Merger Agreement from August 31, 2017 to March 31, 2018, and increased NMM shareholders’ merger consideration payable at the closing of the Merger to include an aggregate of 2,566,666 shares of Common Stock and warrants to purchase an aggregate of 900,000 shares of Common Stock exercisable at $10.00 per share, in addition to such number of shares of Common Stock that represents 82% of the total issued and outstanding shares of Common Stock immediately following the consummation of the Merger and warrants to purchase 850,000 shares of Common Stock at an exercise price of $11 per share.

Pursuant to the Merger Agreement Amendment No. 2, NMM also agreed to provide an additional $4,000,000 working capital loan to us as evidenced by a promissory note in the principal amount of $9,000,000 (the “Restated NMM Note”), which is convertible into shares of Common Stock at a conversion price of $10.00 per share (subject to adjustment for stock splits, dividends, recapitalizations and the like) within 10 business days prior to maturity. The Restated NMM Note amended and restated the NMM Note issued by the Company to NMM on January 3, 2017 in the principal amount of $5,000,000. In addition, pursuant to its terms, the principal amount of the Restated NMM Note shall be increased to $13,990,000 if the Company fails to pay the Amended Alliance Note described below, and NMM will either pay all amounts owed under the Amended Alliance Note or enter into another agreement with Alliance (such that in either case the Amended Alliance Note is cancelled). See Note 7 “Debt - Restated NMM Note” to the accompanying condensed consolidated financial statements for additional information on the Restated NMM Note.

On October 16, 2017, we and Alliance amended the Alliance Note to extend the maturity date for the entire outstanding principal and all accrued and unpaid interest thereon to the earlier of (i) March 31, 2018 or (ii) the date on which the Merger Agreement is terminated, whichever occurs first (the “Alliance Maturity Date”). If the Merger has not been consummated by the Alliance Maturity Date, then the outstanding principal balance and interest will be due 45 days after the Alliance Maturity Date. On the business day following closing of the Merger on or before the Alliance Maturity Date, the principal amount of the amended Alliance Note, together with all accrued and unpaid interest thereon, will automatically be converted into shares of Common Stock, at a conversion price of $10.00 per share, subject to adjustment for stock splits, stock dividends, reclassifications and other similar recapitalization transactions The amended Alliance Note may not be prepaid, in whole or in part, by ApolloMed nor converted into shares of Common Stock voluntarily by Alliance. See Note 7 “Debt - Amended Alliance Note” to the accompanying condensed consolidated financial statements for additional information on the Amended Alliance Note.

36 

Regulatory Matters

We operate in a highly regulated industry and are subject to federal and statement governmental oversight. For example, as a risk-bearing organization (“RBO”), the Company and its affiliates, as applicable, are required to follow regulations of the California Department of Managed Health Care (“DMHC”). The Company must comply with a

As risk-bearing organizations, APC and MMG are required to follow the regulations of the California DMHC, including maintenance of minimum working capital, requirement, Tangible Net Equitytangible net equity (“TNE”) requirement,, cash-to-claims ratio and claims payment requirements prescribed by the DMHC. TNE is defined as net assets less intangibles, less non-allowable assets (which include amounts due from affiliates), plus subordinated obligations. The DMHC determined that, asrequirements. As of February 28, 2016,June 30, 2018 and December 31, 2017, APC was in compliance with these regulations, but MMG an affiliated IPA, was not in compliance with the DMHC’s positive TNE requirement for a RBO.these regulations. As a result, the California DMHC has required MMG to develop and implement a corrective action plan (“CAP”) for such deficiency. MMG received confirmation from substantially all of MMG’s CAP has been submitteddirect contracted health plans, that they have moved membership out of MMG effective May 1, 2018, and as a result, as of June 30, 2018, MMG was approved by DMHCno longer required to be in December 2016. Through an intercompany revolving subordinate loan from AMM (see “Intercompany Loans” below), MMG achieved positive TNEcompliance with these regulations.

Purchase of Interest in New Integrated Care Center

APC, NMM and College Street Investment LP, a California limited partnership (“CSI”) are members of 531 W. College LLC (APC and NMM each own a 25% interest in 531 W. College, LLC). In June 2018, 531 W. College, LLC purchased a recently closed hospital in the thirdCity of Los Angeles for $33,347,000. APC and NMM each contributed their pro rata share of the purchase price (i.e. $8,337,000, each). The plan is to convert the facility into an integrated care center, complete with a 24-hour urgent care center, multispecialty clinics, imaging center, diagnostic lab, pharmacy, behavioral care center, infusion center and also provide telemedicine services. When fully operational, the center will be a one-stop healthcare destination that can provide coordinated, patient-centered care, and maintain the necessary health care services for the community. Contingent upon obtaining the requisite licenses, the repurposed facility could be operational during the fourth quarter of fiscal 20172018. CSI is an unaffiliated entity.

Key Financial Measures and has maintained positive TNEIndicators

Operating Revenues

Our revenue primarily consists of capitation revenue, risk pool settlements and incentives, NGACO All-Inclusive Population-Based Payments (“AIPBP”) revenue, management fee income and fee-for-services (“FFS”) revenue. The form of billing and related risk of collection for such services may vary by type of revenue and the customer.

Operating Expenses

Our largest expense is the patient care cost paid to date. The DMHCcontracted physicians, and the cost of providing management and administrative support services to our affiliated physician groups. These services include payroll, benefits, human resource services, physician practice billing, revenue cycle services, physician practice management, administrative oversight, coding services, and other consulting services.

43

Results of Operations

As noted above, although ApolloMed was the legal acquirer in the Merger, for accounting purposes, the Merger is reviewingtreated as a “reverse acquisition,” and NMM is considered the Company’s filings for MMG to be taken offaccounting acquirer and ApolloMed is the CAP. In addition, MMG arranged for City National Bank (“CNB”) to provide two irrevocable standby letters of credit (see Note 7 “Debt - Standby Letters of Credit and Lines of Credit” toaccounting acquiree. Accordingly, (i) the accompanying condensed consolidated financial statements for additional information). There is no assurance thatincluded in Item 1 above, and the DMHC will agree for MMG to be taken off the CAP. Non-compliance with the TNE requirement or any other applicable regulatory requirement by us, includingdescription of our applicable affiliates, could result in significant consequences, including suspension or terminationresults of operations set forth below for the three and thus adversely affect our business, prospects, revenuessix month periods in 2017 reflect the operations of NMM alone during those periods, and earnings. In addition, changes in compliance requirements or in governmental policies could also impact our operations, revenues(ii) the financial statements and earnings by, among other things, increasing resource spent in our compliance efforts and limiting the scopedescription of our operations.results of operations for the three and six month periods in 2018 reflect the combined operations of ApolloMed and NMM. Because the financial results for the reported periods in 2017 exclude the results of ApolloMed, the following results of operations in 2018 are not directly comparable to our results of operations in the 2017 periods.

 

In addition, we are subjectApollo Medical Holdings, Inc.

Consolidated Statements of Income

(Unaudited)

  For the Three Months Ended       
  June 30,  June 30,       
  2018  2017  $ Change  % Change 
REVENUE                
Capitation, net $90,316,182  $62,879,587  $27,436,595   44%
Risk pool settlements and incentives  13,866,217   8,358,598   5,507,619   66%
Management fee income  12,371,608   6,287,702   6,083,906   97%
Fee-for-services, net  5,679,469   3,044,548   2,634,921   87%
Other income  771,070   741,265   29,805   4%
Total revenue  123,004,546   81,311,700   41,692,846   51%
EXPENSES:                
Cost of services  99,464,892   66,672,236   32,792,656   49%
General and administrative expenses  11,471,829   5,777,187   5,694,642   99%
Depreciation and amortization  4,918,078   4,805,979   112,099   2%
Total expenses  115,854,799   77,255,402   38,599,397   50%
INCOME FROM OPERATIONS  7,149,747   4,056,298   3,093,449   76%
OTHER INCOME (EXPENSES):                
Income (loss) from equity method investments  1,669,861   (795,102)  2,464,963   -310%
Interest expense  (110,683)  (575)  (110,108)  19149%
Interest income  339,816   209,492   130,324   62%
Change in fair value of derivative instrument  -   (1,394,443)  1,394,443   -100%
Other income  340,659   26,624   314,035   1180%
Total other income (expense), net  2,239,653   (1,954,004)  4,193,657   -215%
INCOME BEFORE PROVISION FOR INCOME TAXES  9,389,400   2,102,294   7,287,106   

347

%
Provision for income taxes  1,523,807   736,835   786,972   107%
NET INCOME  7,865,593   1,365,459   6,500,134   476%
                 
Net income (loss) attributable to noncontrolling interests  5,201,491   (629,284)  5,830,775   -927%
NET INCOME ATTRIBUTABLE TO APOLLO MEDICAL HOLDINGS, INC. $2,664,102  $1,994,743  $669,359   34%

44

Apollo Medical Holdings, Inc.

Consolidated Statements of Income

(Unaudited)

  For the Six Months Ended       
  June 30,  June 30,       
  2018  2017  $ Change  % Change 
REVENUE                
Capitation, net $176,221,466  $127,595,720  $48,625,746   38%
Risk pool settlements and incentives  31,852,953   19,495,798   12,357,155   63%
Management fee income  24,446,180   12,824,812   11,621,368   91%
Fee-for-services, net  13,427,578   5,708,461   7,719,117   135%
Other income  1,223,096   1,022,971   200,125   20%
Total revenue  247,171,273   166,647,762   80,523,511   48%
EXPENSES:                
Cost of services  184,135,500   126,214,808   57,920,692   46%
General and administrative expenses  23,207,727   11,053,762   12,153,965   110%
Depreciation and amortization  9,976,590   9,642,330   334,260   3%
Total expenses  217,319,817   146,910,900   70,408,917   48%
INCOME FROM OPERATIONS  29,851,456   19,736,862   10,114,594   51%
OTHER INCOME (EXPENSES):                
Income from equity method investments  1,641,837   1,432,160   209,677   15%
Interest expense  (195,684)  (1,386)  (194,298)  14019%
Interest income  609,634   391,777   217,857   56%
Change in fair value of derivative instrument  -   127,779   (127,779)  -100%
Other income  428,652   28,138   400,514   1423%
Total other income, net  2,484,439   1,978,468   505,971   26%
INCOME BEFORE PROVISION FOR INCOME TAXES  32,335,895   21,715,330   10,620,565   49%
Provision for income taxes  8,752,647   8,626,080   126,567   1%
NET INCOME  23,583,248   13,089,250   10,493,998   80%
                 
Net income attributable to noncontrolling interests  18,758,691   6,744,846   12,013,845   178%
NET INCOME ATTRIBUTABLE TO APOLLO MEDICAL HOLDINGS, INC. $4,824,557  $6,344,404  $(1,519,847)  -24%

Net Income Attributable to federal and state securities laws. Non-compliance with such laws, such as our failing to file information statements for two corporate actions taken by our majority stockholders in written consents in 2012 and 2013, could cause federal or state agencies to take action against us, including imposing fines or penalties on us or restricting our ability to issue securities.Apollo Medical Holdings, Inc.

 

See Note 8 “Commitments and Contingencies - Regulatory MattersOur net income attributable to Apollo Medical Holdings, Inc. for the accompanying condensed consolidated financial statementsthree months ended June 30, 2018 was $2.7 million, as compared to $2.0 million for additional information.the same period in 2017, an increase of $0.7 million, or 34%. Our net income attributable to Apollo Medical Holdings, Inc. for the six months ended June 30, 2018 was $4.8 million, as compared to $6.3 million for the same period in 2017, a decrease of $1.5 million, or 24%.

 

Lines of creditPhysician Groups and Patients

 

BAHA hasAs of June 30, 2018 and 2017, the total number of affiliated physician groups managed by us was 12 and 10 groups, respectively, and the total number of patients for whom we managed the delivery of healthcare services was 1,018,797 and 615,270, respectively.

Revenue

Our revenue for the three months ended June 30, 2018 was $123.0 million, as compared to $81.3 million for the same period in 2017, an increase of $41.7 million, or 51%. The increase in revenue was attributable to (i) an increase of $5.4 million in capitation revenue due to increases in membership and capitation rates, (ii) an increase of $5.5 million in risk pool revenue due to favorable healthcare utilization trends, (iii) an increase in management fee income of $4.9 million, which was mainly driven by an increase in the number of patients served by our affiliated physician groups, (iv) and an increase in fees-for-service revenue of $0.8 million, which was mainly due to increased surgery center income from the increase in patients and fees received. The remaining difference is primarily due to ApolloMed’s pre-Merger operations, which did not have any comparable results from the accounting acquirer (NMM) for the three months ended June 30, 2017.

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Our revenue for the six months ended June 30, 2018 was $247.2 million, as compared to $166.6 million for the same period in 2017, an increase of $80.5 million, or 48%. The increase in revenue was attributable to (i) an increase of $11.9 million in capitation revenue due to increases in membership and capitation rates, (ii) an increase of $12.3 million in risk pool revenue due to favorable healthcare utilization trends, (iii) an increase in management fee income of $8.1 million, which was mainly driven by an increase in the number of patients served by our affiliated physician groups, (iv) an increase in fees-for-service revenue of $2.6 million, which was mainly due to increased surgery center income from the increase in patients and fees received, and (v) increases in other income of $0.1 million. The remaining difference is primarily due to ApolloMed’s pre-Merger operations, which did not have any comparable results from the accounting acquirer (NMM) for the six months ended June 30, 2017.

Cost of Services

Expenses related to cost of services for the three months ended June 30, 2018 were $99.5 million, as compared to $66.7 million for the same period in 2017, an increase of $32.8 million, or 49%. Cost of services for the 2018 period consist of expenses incurred by NMM, ApolloMed and MMG collectively, whereas, cost of services for 2017 period consist solely of expenses incurred by NMM. ApolloMed and MMG’s operations incurred costs of $26.6 million for the three months ended June 30, 2018, which are included in the foregoing $99.5 million of costs. In addition to the increase in cost of services due to the operations of ApolloMed and MMG, we also had an increase of $1.3 million in hospitalist expense, an increase of $2.6 million in personnel costs, and an increase of $10.3 million in medical claims, capitation and other health services expense. This overall increase was offset by the decrease of $8.0 million for provider bonus and incentive for the three months ended June 30, 2018 compared to the three months ended June 30, 2017.

Expenses related to cost of services for the six months ended June 30, 2018 were $184.1 million, as compared to $126.2 million for the same period in 2017, an increase of $57.9 million, or 46%. Cost of services for the 2018 period consist of expenses incurred by NMM, ApolloMed and MMG collectively, whereas, cost of services for 2017 period consist solely of expenses incurred by NMM. ApolloMed and MMG’s operations incurred costs of $50.2 million for the six months ended June 30, 2018, which are included in the foregoing $184.1 million of costs. In addition to the increase in cost of services due to the operations of ApolloMed and MMG, we also had an increase of $5.0 million in personnel costs, an increase of $2.4 million in hospitalist expense, and an increase of $13.9 million in medical claims, capitation and other health services expense. This overall increase was offset by the decrease of $13.6 million for provider bonus and incentive for the six months ended June 30, 2018 compared to the six months ended June 30, 2017.

General and Administrative Expenses

General and administrative expenses for the three months ended June 30, 2018 were $11.5 million, as compared to $5.8 million for the same period in 2017, an increase of $5.7 million, or 99%. The overall increase is mainly due to ApolloMed and MMG’s administrative expenses of $3.0 million for the three months ended June 30, 2018, none of which are included for the same period of the prior year because only NMM’s operations are included in the 2017 periods. In addition to the increase in general and administrative expenses due to the operations of ApolloMed and MMG, we also had an increase of $2.7 million in general and administration expenses due to growth of business for the three months ended June 30, 2018.

General and administrative expenses for the six months ended June 30, 2018 were $23.2 million, as compared to $11.1 million for the same period in 2017, an increase of $12.2 million, or 110%. The overall increase is mainly due to ApolloMed and MMG’s administrative expenses of $6.0 million for the six months ended June 30, 2018, none of which are included for the same period of the prior year because only NMM’s operations are included in the 2017 periods. In addition to the increase in general and administrative expenses due to the operations of ApolloMed and MMG, we also had an increase of $6.2 million increase in general and administration expenses due to growth of business for the six months ended June 30, 2018.

Depreciation and Amortization

Depreciation and amortization expense for the three months ended June 30, 2018 was $4.9 million, as compared to $4.8 million for the same period in 2017, an increase of $0.1 million, or 2%. The increase was attributable to additional property and equipment purchased during 2017 and the amortization of intangible assets from the Merger, offset by a reduction of intangible assets from impairment recorded in the fourth quarter of 2017. The remaining difference is primarily due to ApolloMed’s pre-Merger operations, which did not have any comparable results from the accounting acquirer (NMM) for the three months ended June 30, 2017.

Depreciation and amortization expense for the six months ended June 30, 2018 was $10.0 million, as compared to $9.6 million for the same period in 2017, an increase of $0.3 million, or 3%. The increase was attributable to additional property and equipment purchased during 2017 and the amortization of intangible assets from the Merger, offset by a reduction of intangible assets from impairment recorded in the fourth quarter of 2017. The remaining difference is primarily due to ApolloMed’s pre-Merger operations, which did not have any comparable results from the accounting acquirer (NMM) for the six months ended June 30, 2017.

Income from Equity Method Investments

Income (loss) from equity method investments for the three months ended June 30, 2018 was $1.7 million, as compared to $(0.8) million for the same period in 2017, an increase of $2.5 million, or 310%. This increase reflects a loss of $(0.6) million from our investment in LMA’s IPA line of business, income of $1.7 million from our investment in UCI and income of $0.4 million allocated from our investment in DMG for the three months ended June 30, 2018, compared to a loss from our investment in LMA’s IPA line of business of $(0.8) million, a loss from our investment in UCI of $(0.3) million, and income from our investment in DMG of $0.2 million for the three months ended June 30, 2017. 

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Income (loss) from equity method investments for the six months ended June 30, 2018 was $1.6 million, as compared to $1.4 million for the same period in 2017, an increase of $0.2 million, or 15%. This increase is mainly due to the loss of $(1.0) million from our investment in LMA’s IPA line of business, offset by the income of $1.7 million allocated from our investment in UCI, income of $0.7 million allocated from our investment in DMG and income of $0.1 million allocated from our investment in PASC for the six months ended June 30, 2018, compared to income from our investment in LMA’s IPA line of business of $0.5 million, income from our investment in UCI of $0.2 million, income from our investment in PMIOC of $0.1 million and income from our investment in DMG of $0.6 million for the six months ended June 30, 2017. 

Interest Expense

Interest expense for the three and six months ended June 30, 2018 of $0.1 million and $0.2 million, respectively, reflects interest on debt obligations associated with bank loans. NMM had de minimus interest expense in the same periods of 2017.

Interest Income

Interest income for the three and six months ended June 30, 2018 increased by approximately $0.1 million and $0.2 million, respectively, as compared to the same period in 2017 mainly due to an increase in cash held in money market accounts which resulted in an increase in interest earned and the interest from notes receivable.

Change in Fair Value of Derivative Instruments

(Loss) gain from change in fair value of derivative instruments for the three and six months ended June 30, 2017 was approximately $(1.4) million and $0.1 million, respectively, mainly due to changes in stock price of ApolloMed’s common stock during the six months ended June 30, 2017 with no recurring amounts for the same period in 2018. 

Other Income

Other income for the three and six months ended June 30, 2018 was approximately $0.3 million and $0.4 million, respectively, as compared to approximately $27,000 and $28,000, respectively, for the same period in 2017 mainly due to rental income received.

Provision for Income Taxes

Provision for income taxes was $1.5 million for the three months ended June 30, 2018, as compared to $0.7 million for the same period in 2017, an increase of $0.8 million or 107%. The increase is due to the increase in taxable income, as described above, and was partially offset by the decrease in the federal statutory rate of 35% to 21% enacted on December 22, 2017.

Provision for income taxes was $8.7 million for the six months ended June 30, 2018, as compared to $8.6 million for the same period in 2017, an increase of $0.1 million, or 1%. The increase is due to the increase in taxable income, as described above, and was partially offset by the decrease in the federal statutory rate of 35% to 21% enacted on December 22, 2017.

Net Income Attributable to Noncontrolling Interests

Net income (loss) attributable to noncontrolling interests was $5.2 million for the three months ended June 30, 2018, compared to $(0.6) million for the three months ended June 30, 2017, an increase of $5.8 million, or 927%. This increase was primarily due to net income generated from APC mainly attributable to its increased revenue and certain tax benefits.

Net income (loss) attributable to noncontrolling interests was $18.7 million for the six months ended June 30, 2018, compared to $6.7 million for the six months ended June 30, 2017, an increase of $12.0 million, or 178%. This increase was primarily due to net income generated from APC mainly attributable to its increased revenue and certain tax benefits.

Liquidity and Capital Resources

Cash, cash equivalents and investment in marketable securities at June 30, 2018 totaled $102.3 million. Working capital totaled $63.6 million at June 30, 2018, compared to $34.6 million at December 31, 2017, an increase of $29.0 million, or 84%.

We have historically financed our operations primarily through internally generated funds. We generate cash primarily from capitations, risk pool settlements and incentives, fees for medical management services provided to our affiliated physician groups, as well as fee-for-service reimbursements. We generally invest cash in money market accounts, which are classified as cash and cash equivalents. We believe we have sufficient liquidity to fund our operations at least through the next twelve months.

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Our cash, cash equivalents and restricted cash decreased by $8.6 million from $118.5 million at December 31, 2017 to $109.9 million at June 30, 2018. Cash provided by operating activities during the six months ended June 30, 2018 was $13.4 million. The cash generated from operations during the six months ended June 30, 2018 is a function of net income of $23.6 million, adjusted for the following non-cash operating items: depreciation and amortization of $10.0 million, share-based compensation of $1.0 million, loss from disposal of property and equipment of approximately $42,000, income from equity method investments of approximately $1.6 million and change in deferred tax liability of $0.7 million. Our cash provided by operating activities includes a net decrease in operating assets and liabilities of $20.3 million.

Cash used in investing activities during the six months ended June 30, 2018 was $20.3 million, due to cash flow from investing activities attributable to advances to related parties of $2.5 million, purchase of investments of $17.1 million and purchases of property and equipment of $0.7 million, during the six months ended June 30, 2018.

Cash used in financing activities during the six months ended June 30, 2018 was $1.7 million reflecting dividend payments of $12.0 million and repayment of bank loans of $0.3 million, offset by proceeds from exercise of stock options and warrants of $2.3 million, borrowings on line of credit of $150,000$8.0 million and proceeds from sale of stock of $0.2 million during the six months ended June 30, 2018.

Credit Facilities

Lines of Credit

NMM has a credit facility with First Republic Bank. BorrowingsPreferred Bank to borrow up to $20,000,000 that matures on June 22, 2020. The amount outstanding as of June 30, 2018 and December 31, 2017 was $13,000,000 and $5,000,000, respectively and is classified as long-term and current liabilities, respectively. The interest rate is based on the Wall Street Journal “prime rate” plus 0.125%, or 5.125% and 4.625%, as of June 30, 2018 and December 31, 2017, respectively. As of December 31, 2017, NMM was not in compliance with certain financial debt covenant requirements contained in the loan agreement. However, as of June 30, 2018, NMM was in compliance with such financial debt covenant requirements. As of June 30, 2018 and December 31, 2017, availability under thethis line of credit bearwas $300,671 and $8,300,671, respectively.

APC has a credit facility with Preferred Bank to borrow up to $10,000,000 that matures on June 22, 2020. No amounts have been drawn on this facility. The interest atrate is based on the prime rate (as defined)Wall Street Journal “prime rate” plus 3.0% (7.25%0.125%, or 5.125% and 7.0% per annum at September 30, 2017 and March 31, 2017, respectively). We have an outstanding balance of $25,000 and $62,5004.625%, as of SeptemberJune 30, 20172018 and MarchDecember 31, 2017, respectively. TheAs of December 31, 2017, APC was not in compliance with certain financial debt covenant requirements contained in the loan agreement. However, as of June 30, 2018, APC was in compliance with such financial debt covenant requirements. As of both June 30, 2018 and December 31, 2017, availability under this line of credit was $9,694,984. Because APC is unsecured.a VIE of NMM, loans obtained by APC can only be used to fund the operations of that company, and, accordingly, we are not liable for the repayment of any of APC’s borrowings under the Preferred Bank credit facility. In addition, this credit facility is not available to support NMM’s liquidity needs, and can only be used for APC.

 

ConcentrationIn December 2010, ICC borrowed $4,600,000 from a financial institution. The interest rate is based on the Wall Street Journal “prime rate,” but not be less than 4.5% per annum. The loan matures on December 31, 2018. As of Payors

We have a few key payors that represent a significant portion of our accounts receivable.

Receivables from Government - Medicare/Medi-Cal amounted to approximately 24.3 %June 30, 2018 and 20.5% of total accounts receivable as of September 30, 2017 and MarchDecember 31, 2017, respectively. Receivables from Allied Physicians amounted to 12.5%the balance outstanding was $278,017 and 12.8% of accounts receivable as of September 30, 2017 and March 31, 2017,$510,391, respectively. The Company anticipates that Medicare/Medi-Cal and Allied Physicians will continue to be significant payors.

 

Intercompany Loans

 

Each of AMH, MMG, BAHA, ACC, MMG, AKM SCHC and BAHASCHC has entered into an intercompany loan agreementIntercompany Loan Agreement with AMM under which AMM has providedagreed to provide a revolving loan commitment to each of thesuch affiliated entities in an amount set forth in each Intercompany Loan Agreement. Each Intercompany Loan Agreement provides that AMM’s obligation to make any advances automatically terminates concurrently with the loan agreement.termination of the management agreement with the applicable affiliated entity. In addition, each Intercompany Loan Agreement provides that (i) any material breach by Dr. Hosseinion of the applicable Physician Shareholder Agreement or (ii) the termination of the management agreement with the applicable affiliated entity constitutes an event of default under the Intercompany Loan Agreement. All the intercompany loans have been eliminated in consolidation. The following is a summary of the intercompany loans during the six-month period ended June 30, 2018:

 

We had the following outstanding intercompany loans as of September 30, 2017 and March 31, 2017, respectively:

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           Six Months Ended September 30, 2017 
Entity Facility  Expiration  Interest rate per Annum  Maximum Balance
During Period
  Ending Balance  Principal Paid During
Period
  Interest Paid During
Period
 
                      
AMH $10,000,000   9/30/2018   10% $5,204,341  $3,820,391  $1,700,000  $- 
ACC  1,000,000   7/31/2018   10%  1,287,843   1,287,843   -   - 
MMG  3,000,000   2/1/2018   10%  2,392,266   2,392,266   -   - 
AKM  5,000,000   5/30/2019   10%  -   -   -   - 
SCHC  5,000,000   7/21/2019   10%  3,169,014   3,169,014   -   - 
BAHA  250,000   7/22/2021   10%  2,081,096   2,081,096   -   - 
  $24,250,000        $14,134,560  $12,750,610  $1,700,000  $- 


           Year Ended March 31, 2017 
Entity Facility  Expiration  Interest rate per Annum  Maximum Balance
During Period
  Ending Balance  Principal Paid During
Period
  Interest Paid During
Period
 
                      
AMH $10,000,000   9/30/2018   10% $4,904,147  $4,904,147  $-  $- 
ACC  1,000,000   7/31/2018   10%  1,287,843   1,287,843   5,000   - 
MMG  2,000,000   2/1/2018   10%  1,918,724   1,255,111   725,107   - 
AKM  5,000,000   5/30/2019   10%  -   -   -   - 
SCHC  5,000,000   7/21/2019   10%  3,079,916   3,079,916   50,000   - 
BAHA  250,000   7/22/2021   10%  1,171,526   1,171,526   -     
  $23,250,000          $12,362,156  $11,698,543  $780,107  $- 

 

On August 31, 2017, AMM and MMG entered into Amendment No. 1 to their Intercompany Revolving Loan Agreement dated November 22, 2016 to increase the revolving loan commitment by AMM under the loan agreement from $2,000,000 to $3,000,000, and Amendment No. 1 to their Subordination Agreement also dated November 22, 2016 to reflect the increased revolving loan commitment. See Note 8 “Commitments and Contingencies - Regulatory Matters” to the accompanying condensed consolidated financial statements.

          Six Months Ended June 30, 2018 
          Maximum          
       Interest rate  Balance During     Principal Paid  Interest Paid 
Entity Facility  Expiration per Annum  Period  Ending Balance  During Period  During Period 
AMH $10,000,000  09/30/2018  10% $5,150,678  $4,454,133  $(1,674,431) $- 
ACC  1,000,000  07/31/2018  10%  1,287,843   1,287,843   -   - 
MMG  3,000,000  11/22/2021  10%  2,917,119   2,917,119   (1,579)  - 
AKM  5,000,000  05/30/2019  10%  -   -   -   - 
SCHC  5,000,000  07/21/2019  10%  3,468,500   3,327,195   (462,656)  - 
BAHA  250,000  07/22/2021  10%  4,807,584   4,281,658   (530,000)  - 
  $24,250,000        $17,631,724  $16,267,948  $(2,668,666) $- 

 

Critical Accounting Policies and Estimates

 

The preparation of financial statements and related disclosures in conformity with accounting principles generally accepted in the United States of America (“U.S. GAAPGAAP”) requires our management to make judgments, assumptions and estimates that affect the amounts of revenue, expenses, income, assets and liabilities, reported in our condensed consolidated financial statements and accompanying notes. Actual results and the timing of recognition of such amounts could differ from those judgments, assumptions and estimates. In addition, judgments, assumptions and estimates routinely require adjustment based on changing circumstances and the receipt of new or better information. Understanding our accounting policies and the extent to which our management uses judgment, assumptions and estimates in applying these policies, therefore, is integral to understanding our financial statements. Critical accounting policies and estimates are defined as those that are reflective of significant judgments and uncertainties, and potentially result in materially different results under different assumptions and conditions. We summarize our most significant accounting policies in relation to the accompanying condensed consolidated financial statements in Note 2 thereto. Please also refer to the Critical Accounting Policies section of Management’s Discussion and Analysis of Financial Condition and Results of Operations included in our Annual Report on Form 10-K for the fiscal year ended MarchDecember 31, 2017.

The Company recorded a net increase to beginning retained earnings and noncontrolling interest in APC of $1.0 million and $7.4 million, respectively, as of January 1, 2018 due to the cumulative impact of adopting Accounting Standards Update (“ASU”) No. 2014-09, Revenue from Contracts with Customers (Topic 606). The impact to beginning retained earnings and noncontrolling interest was primarily driven by the determination of risk pool settlement revenue (including the estimation of constraints and incurred but not reported completion factor). The adoption of this ASU did not have a significant impact on revenue when comparing the amount of revenue recognized for the six months ended June 30, 2018 to the revenue that would have been recognized under the prior revenue standard ASC 605, such that comparisons of revenues and operating profit performance between periods are not affected by the adoption of this ASU. Refer to Notes 2 and 13 to the accompanying condensed consolidated financial statements.

 

New Accounting Pronouncements

 

See Note 2 to the accompanying condensed consolidated financial statements for recently issued accounting pronouncements, including information on new accounting standards and the future adoption of such standards.

 

Off Balance Sheet Arrangements

 

As of SeptemberJune 30, 2017,2018, we had no off-balance sheet arrangements.

 

ITEM 3.  QUANTITATIVE AND QUALITATIVE DISCLOSURES ABOUT MARKET RISK

 

Not applicable.

 

ITEM 4.  CONTROLS AND PROCEDURES

 

We conducted an evaluation, under the supervision and with the participation of management, including our chief executive officer and chief financial officer, of the effectiveness of the design and operation of our disclosure controls and procedures (as defined in Rules 13a-15(e) and 15d-15(e) under the Securities Exchange Act of 1934, as amended) as of the end of the period covered by this quarterly report. Based on this evaluation, our chiefco-chief executive officerofficers and chief financial officer concluded that, as of the evaluation date, our disclosure controls and procedures were effective at the reasonable assurance level.

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Our disclosure controls and procedures are designed to ensure that the information relating to our company, including our consolidated subsidiaries, required to be disclosed in our SEC reports is recorded, processed, summarized and reported within the time periods specified in SEC rules and forms, and is accumulated and communicated to our management, including our chiefco-chief executive officerofficers and chief financial officer, as appropriate to allow for timely decisions regarding required disclosure.

 


Our management, including our chiefco-chief executive officerofficers and chief financial officer, does not expect that our disclosure controls or our internal control over financial reporting will prevent or detect all errors and all fraud. A control system, no matter how well designed and operated, can provide only reasonable, not absolute, assurance that the control system’s objectives will be met. The design of any system of controls is based in part on certain assumptions about the likelihood of future events, and there can be no assurance that any design will succeed in achieving its stated goals under all potential future conditions, and must reflect the facts that there are resource constraints and that the benefits of controls have to be considered relative to their costs. The inherent limitations in internal control over financial reporting include the realities that judgments can be faulty and that breakdowns can occur because of simple error or mistake. Controls also can be circumvented by the individual acts of some persons, by collusion of two or more people, or by management override of controls. In addition, over time, controls may become inadequate because of changes in circumstances, or the degree of compliance with the policies and procedures may deteriorate.

 

Changes in Internal Control Over Financial Reporting 

There have not been any changes in our internal control over financial reporting (as defined in Rule 13a-15(f) under the Securities Exchange Act of 1934, as amended) during the period covered by this quarterly report that have materially affected, or are reasonably likely to materially affect, our internal control over financial reporting.

 

PART II – OTHER INFORMATION

 

ITEM 1.  LEGAL PROCEEDINGS

 

In the ordinary course of our business, we from time to time become involved in pending and threatened legal actions and proceedings, most of which involve claims of medical malpractice related to medical services that are provided by our affiliated hospitalists. Many of the Company’s payerpayor and provider contracts are complex in nature and may be subject to differing interpretations regarding amounts due for the provision of medical services, which may not come to light until a substantial period of time has passed following contract implementation. We may also become subject to other lawsuits which could involve significant claims and/or significant defense costs, but as of the date of this Quarterly Report on Form 10-Q, except as disclosed, we are not a party to any lawsuit or proceeding, which in the opinion of management is expected to individually or in the aggregate have a material adverse effect on us or our business. Nonetheless, the resolution of any claim or litigation is subject to inherent uncertainty and could have a material adverse effect on the Company’s financial condition, cash flows or results of operations. Nonetheless,

On or about March 23, 2018 and April 3, 2018, a Demand for Arbitration and an Amended Demand for Arbitration were filed by Prospect Medical Group, Inc. and Prospect Medical Systems, Inc. (collectively, “Prospect”) against MMG, ApolloMed and AMM with Judicial Arbitration Mediation Services in California, arising out of MMG’s purported business plans, seeking damages in excess of $5 million, and alleging breach of contract, violation of unfair competition laws, and tortious interference with Prospect’s current and future economic relationships with its health plans and their members. MMG, ApolloMed and AMM each dispute the resolution of any claim or litigation is subjectallegations and intend to inherent uncertainty and could have a material adverse effect on the Company’s financial condition, cash flows or results of operations. See Note 8 “Commitments and Contingencies - Legal Actions and Proceedings” to the accompanying condensed consolidated financial statements for additional comments.vigorously defend against this matter.

 

ITEM 1A. RISK FACTORS

 

Our business, financial condition and operating results are affected by a number of factors, whether currently known or unknown, including risks specific to us or the healthcare industry as well as risks that affect businesses in general. In addition to the information and risk factors set forth in this Quarterly Report, you should carefully consider the factors discussed in Part I, Item 1A, “Risk Factors” in our Annual Report on Form 10-K for the year ended MarchDecember 31, 2017 filed with the SEC on June 29, 2017 and risk factors discussed in the Registration Statement Amendment No.April 2, on Form S-4/A filed with the SEC by us and Network Medical Management, Inc. (“NMM”) on November 9, 2017 (available at www.sec.gov).2018. The risks disclosed in such Annual Report in such Registration Statement Amendment and in this Quarterly Report could materially adversely affect our business, financial condition, cash flows or results of operations and thus our stock price. While we believe there have been no material changes in our risk factors from those disclosed in the Annual Report, or the Registration Statement Amendment, other than those discussed below, additional risks and uncertainties not currently known or we currently deem to be immaterial may also materially adversely affect our business, financial condition or results of operations.

 

The following discussion of risk factors contains forward-looking statements. These risk factors may be important to understanding other statements in this Quarterly Report. The following informationReport and should be read in conjunction with the condensed consolidated financial statements and related notes in Part I, Item 1, “Financial Statements” and Part I, Item 2, “Management’s Discussion and Analysis of Financial Condition and Results of Operations” of this Quarterly Report. Because of the followingsuch risk factors, as well as other factors affecting the Company’s financial condition and operating results, past financial performance should not be considered to be a reliable indicator of future performance, and investors should not use historical trends to anticipate results or trends in future periods.

 

The Merger has not yet been consummated despite the filing of the associated Registration Statement on Form S-4 and Amendments thereof with the SEC. The failure to consummate the Merger could have a material adverse effect on ApolloMed’s business, including that ApolloMed may be unable to repay its debt, and any delay in completing the Merger may substantially reduce the benefits to ApolloMed.I

Consummation of the Merger is subject to various closing conditions, including approval by both ApolloMed’s stockholders and the shareholders of NMM, many of which have not yet occurred. ApolloMed may need to waive one or more closing conditions in order to complete the Merger, including without limitation, (a) the approval of the proposed Merger by the affirmative vote of NMM shareholders (x) holding at least 95% of the outstanding shares of NMM’s common stock and (y) representing at least 95% in number of the NMM shareholders; (b) at the closing of the Merger, there are (i) no dissenting NMM shareholders (as defined in the Merger Agreement as amended) and (ii) no NMM shareholders who have exercised their dissenters’ rights under the California General Corporation Law and have not withdrawn such exercise or otherwise have become ineligible to effect such exercise; and (c) the delivery of a duly executed lock-up agreement by each NMM shareholder, other than dissenting shareholders, at or before the Closing.


If for any reason the Merger is not consummated, upon the termination of the Merger Agreement, ApolloMed would have significant financial obligations to its creditors, including NMM. For example, ApolloMed has incurred debt under the Amended Alliance Note and the Restated NMM Note in the aggregate of almost $14,000,000. See Note 7 to the accompanying condensed consolidated financial statements for additional information. As such notes are unsecured andpari passu, ApolloMed may have insufficient funds to repay the two notes if both become due upon the termination of the Merger Agreement.

In addition, as ApolloMed anticipates that NMM will be an important future source of working capital for ApolloMed after the consummation of the Merger, if the Merger does not occur, ApolloMed would not benefit from such additional working capital. Furthermore, there are several areas of operations in which NMM and ApolloMed work together, including APAACO, which is owned 50% by NMM and 50% by ApolloMed, as well as management services agreements ApolloMed has with certain NMM affiliates. If for any reason the Merger is not consummated, ApolloMed cannot predict the effect this would have on areas where ApolloMed operates together with NMM and for which ApolloMed is dependent upon significant revenue.

If the Merger is not completed within the expected time frame, such delay could result in additional transaction costs or other adverse effects associated with uncertainty about the Merger. As a result, the ongoing businesses of ApolloMed could be adversely affected, including being subject to the following risks:

·certain costs related to the Merger, such as legal and accounting fees, must be paid even if the Merger is not completed;
·if the Merger Agreement is terminated under certain circumstances, either party may be required to pay the other party a termination fee of  $1.5 million, as applicable;
·the attention of management of ApolloMed may have been diverted to the Merger rather than to ApolloMed’s own operations and the pursuit of other opportunities that could have been beneficial;
·the potential loss of key personnel during the pendency of the Merger as employees may experience uncertainty about their future roles with the combined company;
·reputational harm due to the adverse perception of any failure to successfully complete the Merger;
·the price of ApolloMed stock may decline;
·ApolloMed will have been subject to certain restrictions on the conduct of its business which may have prevented it from making certain acquisitions or dispositions or pursuing certain business opportunities while the Merger was pending; and
·ApolloMed may be subject to litigation related to the Merger or any failure to complete the Merger.

Furthermore, if the Merger Agreement is terminated, ApolloMed is likely to have an immediate financial need to raise additional capital to fund ApolloMed’s business and meet ApolloMed’s expenses, including both transactional and operational expenses.

ApolloMed and its board of directors may be subject to liability for failure to fully comply with federal and state securities laws.

ApolloMed is subject to federal and state securities laws. Any failure to comply with such laws, such as ApolloMed’s failing to file information statements for two corporate actions taken by its majority stockholders in written consents in 2012 and 2013, could cause federal or state agencies to take action against ApolloMed, which could restrict its ability to issue securities and result in fines or penalties. Any claims brought by such an agency could also cause ApolloMed to expend resources to defend itself, would divert the attention of its management from ApolloMed’s core business and could significantly harm ApolloMed’s business, operating results and financial condition, even if the claims are resolved in ApolloMed’s favor. Further, at ApolloMed’s 2016 annual meeting, its stockholders voted on the frequency of their future votes on its executive compensation. ApolloMed inadvertently failed to file, within 150 days after the meeting, a Form 8-K amendment to disclose its decision as to how frequently it will hold such a vote, resulting in ApolloMed’s failing to file all reports required to be filed by Section 13 or 15(d) of the Exchange Act for at least 12 months before filing certain subsequent periodic and other reports. While ApolloMed filed the Form 8-K amendment on November 3, 2017, such failure may adversely affect the effectiveness of ApolloMed’s registration statement on Form S-8 filed in May 2016 and ApolloMed may need to refile such registration statement. This failure also hinders ApolloMed’s ability to issue securities in certain transactions and raise additional capital, including being unable to use Form S-3 for a substantial period of time. ApolloMed may also be subject to certain other restrictions or fines or penalties.

In addition, a plaintiffs’ securities law firm has announced that it is investigating ApolloMed and its board of directors for potential federal law violations and breaches of fiduciary duties in connection the Merger. This investigation purportedly focuses on whether ApolloMed and its board of directors violated federal securities laws or breached their fiduciary duties to ApolloMed’s stockholders by failing to properly value the Merger and failing to disclose all material information in connection with the Merger. While we believe that our board of directors and management have faithfully upheld their fiduciary duties in negotiating and executing the Merger for the combined interest of all of ApolloMed’s stockholders, we cannot preclude the possibility that this investigation and any lawsuit brought relating to any alleged federal law violations and/or breaches of fiduciary duty in connection with the Merger could result in a delay of the Merger, as well as the potentially significant expenditures of time and resources to defend any such lawsuit. As a result, our management and board of directors may have less time to devote to our business, the consummation of the Merger and the successful integration of the business of ApolloMed and NMM.


APAACO’s future participation in the AIPBP Payment Mechanism is uncertain and payments thereunder represent a significant part of ApolloMed’s total revenues. ApolloMed also cannot accurately predict and monitor its performance under the AIPBP payment mechanism.

APAACO chose to participate in the All-Inclusive Population-Based Payment (“AIPBP”) payment mechanism. Under the AIPBP payment mechanism, CMS estimates the total annual Part A and Part B Medicare expenditures of APAACO’s assigned Medicare beneficiaries and pays that projected amount in per beneficiary per month payments. In October 2017, CMS notified APAACO that it has not been renewed for participation in the AIPBP payment mechanism of the NGACO Model for performance year 2018 due to certain alleged deficiencies in performance by APAACO. APAACO does not believe the allegations by CMS of performance deficiencies are valid or justify the CMS non-renewal determination and is in discussions with CMS regarding possible reversal of such determination. On November 9, 2017, APAACO submitted a request for reconsideration to CMS. If APAACO is not successful in convincing CMS to reverse its decision then the payment mechanism under the NGACO Model would default to traditional Fee For Service (“FFS”). This would result in the loss in monthly revenues and cash flow currently being generated by APAACO, currently at a rate of approximately $9.3 million per month, and would thus have a material adverse effect on ApolloMed’s future revenues and potential cash flow.

In addition, APAACO chose “Risk Arrangement A,” comprising 80% risk for Part A and Part B Medicare expenditures and a shared savings and losses cap of 5%, or as a result a 4% effective shared savings and losses cap when factoring in 80% risk impact. APAACO’s benchmark Medicare Part A and Part B expenditures for beneficiaries for its 2017 performance year are approximately $335 million, and under “Risk Arrangement A” of the AIPBP payment mechanism APAACO could therefore have profits or be liable for losses of up to 4% of such benchmarked expenditures, or approximately $13.4 million. While performance can be monitored throughout the year, end results will not be known until 2018. ApolloMed cannot accurately predict and monitor performance under the AIPBP payment mechanism for 2017 because, among other factors, end results are released annually rather than on a more frequent basis.

Actual ApolloMed results are significantly different from those contained in the cash flow and other projections prepared in late 2016 by ApolloMed management and used by BofA Merrill Lynch in its financial analyses in connection with the Merger.

ApolloMed management prepared certain financial projections, which were based on management's projection of ApolloMed’s future financial performance as of the date provided in late 2016. These projections were not prepared with a view toward public disclosure or compliance with published guidelines of the SEC regarding forward-looking information. More importantly, the cash flow and other financial projections were based on a number of assumptions and predictions that have not turned out to be accurate, and with the passage of time, ApolloMed’s actual results differ materially from those forecasts in the cash flow and other financial projections and, given intervening events, such as CMS’s nonrenewal of APAACO’s participation in the AIPBP payment mechanism of the NGACO Model, results will likely continue to differ materially from these projections and thus, are no longer valid. ApolloMed directed Merrill Lynch, Pierce, Fenner & Smith Incorporated (“BofA Merrill Lynch”) to use such projections, including cash flow projections, in its financial analysis in connection with the Merger. These cash flow projections would no longer be reliable or merit much weight in the context of a discounted cash flow analysis.

No assurance can be given that ApolloMed’s NASDAQ application will be approved at or following the closing of the Merger. There has been a limited trading market for ApolloMed’s common stock (“Common Stock”) to date and it may continue to be the case even if the Merger is consummated and ApolloMed’s listing on the NASDAQ Global Market is approved.

There has been limited trading volume in Common Stock, which is currently quoted on OTC Pink and traded under the symbol “AMEH.” Although ApolloMed has applied for listing of Common Stock on the NASDAQ Global Market effective as of the closing of the Merger, no assurance can be given that ApolloMed can meet the listing requirements for the NASDAQ Global Market, including at the closing of the Merger, or that ApolloMed’s application will ever be approved. If ApolloMed’s application to list Common Stock on the NASDAQ Global Market effective as of the closing of the Merger is not approved, shares of Common Stock to be issued to NMM shareholders in connection with the Merger will need to be qualified under, or otherwise be issued in compliance with, applicable state securities or “blue sky” laws. This compliance effort could add substantial costs and may not be successful, and as a result, ApolloMed may face significant adverse regulatory actions, including fines and penalties.

It is anticipated that there will continue to be a limited trading market for Common Stock even if ApolloMed’s listing application is approved. A lack of an active market may impair the ability of ApolloMed’s stockholders to sell shares at the time they wish to sell or at a price that they consider favorable. The lack of an active market may also reduce the fair market value of Common Stock, impair ApolloMed’s ability to raise capital by selling shares of capital stock and may impair ApolloMed’s ability to Common Stock as consideration to attract and retain talent or engage in business transactions (including mergers and acquisitions).

The requirements of remaining a public company, including following the closing of Merger, and the new requirements under the NASDAQ listing rules that ApolloMed may become subject to if it successfully uplists to NASDAQ may strain ApolloMed’s resources and distract ApolloMed’s management, which could make it difficult to manage its business.

As a public company, ApolloMed, including following the closing of Merger, is required to comply with various regulatory and reporting requirements, including those required by the SEC. If ApolloMed uplists to NASDAQ, ApolloMed will become subject to NASDAQ listing rules. Complying with these requirements are time-consuming and expensive, creating pressure on ApolloMed’s financial resources and, accordingly, ApolloMed’s results of operations and financial condition.


ITEMTEM 2.  UNREGISTERED SALES OF EQUITY SECURITIES AND USE OF PROCEEDS

 

None.

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ITEM 3.  DEFAULTS UPON SENIOR SECURITIES

 

None.

 

ITEM 4. MINE SAFETY DISCLOSURES

 

Not applicable.

 

ITEM 5.  OTHER INFORMATION

 

None.

 

ITEM 6.  EXHIBITS

 

The following exhibits are either incorporated by reference into this Report or filed or furnished with this report,Quarterly Report on Form 10-Q, as indicated below.

 

Exhibit

No.

 Description
   
3.1*2.1†Agreement and Plan of Merger, dated December 21, 2016, among Apollo Medical Holdings, Inc., Network Medical Management, Inc., Apollo Acquisition Corp. and Kenneth Sim, M.D. (the “Merger Agreement”) (incorporated herein by reference to Annex A to the joint proxy statement/prospectus filed pursuant to Rule 424(b)(3) on November 15, 2017 that is a part of a Registration Statement on Form S-4).
2.2Amendment to the Merger Agreement, dated March 30, 2017, among Apollo Medical Holdings, Inc., Network Medical Management, Inc., Apollo Acquisition Corp. and Kenneth Sim, M.D. (incorporated herein by reference to Annex A to the joint proxy statement/prospectus filed pursuant to Rule 424(b)(3) on November 15, 2017 that is a part of a Registration Statement on Form S-4).
2.3Amendment No. 2 to the Merger Agreement, dated October 17, 2017, among Apollo Medical Holdings, Inc., Network Medical Management, Inc., Apollo Acquisition Corp. and Kenneth Sim, M.D. (incorporated herein by reference to Annex A to the joint proxy statement/prospectus filed pursuant to Rule 424(b)(3) on November 15, 2017 that is a part of a Registration Statement on Form S-4).
3.1 Restated Certificate of Incorporation (filed as an exhibit(incorporated herein by reference to aExhibit 3.1 to the Company’s Current Report on Form 8-K filed on January 21, 2015).
   
3.2*3.2 Certificate of Amendment toof Restated Certificate of Incorporation (filed as an exhibit(incorporated herein by reference to aExhibit 3.1 to the Company’s Current Report on Form 8-K filed on April 27, 2015).
   
3.3*3.3Certificate of Amendment of Restated Certificate of Incorporation (incorporated herein by reference to Exhibit 3.1 to the Company’s Current Report on Form 8-K filed on December 13, 2017).
3.4Certificate of Amendment of Restated Certificate of Incorporation (incorporated herein by reference to Exhibit 3.1 to the Company’s Current Report on Form 8-K filed June 21, 2018).
3.5Restated Bylaws (incorporated herein by reference to Exhibit 3.2 to the Company’s Quarterly Report on Form 10-Q filed on November 16, 2015).
3.6Amendment to Sections 3.1 and 3.2 of Article III of Bylaws (incorporated herein by reference to Exhibit 3.2 to the Company’s Current Report on Form 8-K filed on December 13, 2017).
3.7Amendment to Sections 3.1 and 3.2 of Article III of Bylaws (incorporated herein by reference to Exhibit 3.2 to the Company’s Current Report on Form 8-K filed on June 21, 2018).
4.1 Certificate of Designation of Series A Convertible Preferred Stock (filed as an exhibit(incorporated herein by reference to aExhibit 3.1 to the Company’s Current Report on Form 8-K filed on October 19, 2015).
   
3.4*4.2 Amended and Restated Certificate of Designation (filed as an exhibitof Apollo Medical Holdings, Inc. (incorporated herein by reference to aExhibit 3.1 to the Company’s Current Report on Form 8-K filed on April 4, 2016).

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4.3Form of Certificate for Common Stock of Apollo Medical Holdings, Inc., par value $0.001 per share (incorporated herein by reference to Exhibit 4.1 to the Company’s Annual Report on Form 10-K filed on April 2, 2018).
4.4Form of Warrant issued as Merger Consideration pursuant to the Merger Agreement for the purchase of Common Stock of Apollo Medical Holdings, Inc., exercisable at $11.00 per share (incorporated herein by reference to Exhibit 4.3 to the Company’s Annual Report on Form 10-K filed on April 2, 2018).
4.5Form of Warrant issued as Merger Consideration pursuant to the Merger Agreement for the purchase of Common Stock of Apollo Medical Holdings, Inc., exercisable at $10.00 per share (incorporated herein by reference to Exhibit 4.4 to the Company’s Annual Report on Form 10-K filed on April 2, 2018).
4.6Common Stock Purchase Warrant (“Series A Warrant”) dated October 14, 2015, originally issued by Apollo Medical Holdings, Inc. to Network Medical Management, Inc. to purchase 1,111,111 shares of common stock and subsequently issued as Merger Consideration pursuant to the Merger Agreement (incorporated herein by reference to Exhibit 4.1 to the Company’s Current Report on Form 8-K filed on October 19, 2015).
4.7Form of Assignment of Series A Warrant as Merger Consideration pursuant to the Merger Agreement (incorporated herein by reference to Exhibit 4.6 to the Company’s Annual Report on Form 10-K filed on April 2, 2018).
4.8Common Stock Purchase Warrant (“Series B Warrant”) dated March 30, 2016, originally issued by Apollo Medical Holdings, Inc. to Network Medical Management, Inc. to purchase 555,555 shares of common stock and subsequently issued as Merger Consideration pursuant to the Merger Agreement (incorporated herein by reference to Exhibit 4.1 to the Company’s Current Report on Form 8-K filed on April 4, 2016).
   
3.5*4.9 Restated Bylaws (filedForm of Assignment of Series B Warrant as an exhibitMerger Consideration pursuant to a Quarterlythe Merger Agreement (incorporated herein by reference to Exhibit 4.8 to the Company’s Annual Report on Form 10-Q10-K filed on November 16, 2015)April 2, 2018).
   
4.1*4.10 Form of InvestorCommon Stock Purchase Warrant dated as of October 29, 2012, for the purchase of common stock,November 4, 2016, issued by Apollo Medical Holdings, Inc. in connection with its 10% Senior Subordinated Callable Convertible Notes (filed as an exhibit, to a QuarterlyScott Enderby, D.O. (incorporated herein by reference to Exhibit 4.1 to the Company’s Current Report on Form 10-Q8-K filed on December 17, 2012)November 10, 2016).
   
4.2*Form of Investor Warrant, undated, for the purchase of common stock, issued by Apollo Medical Holdings, Inc. in connection with its 9% Senior Subordinated Convertible Notes (filed as an exhibit to an Annual Report on Form 10-K on May 1, 2013).
4.3**Stock Purchase Warrant dated as of July 21, 2014, issued by Apollo Medical Holdings, Inc. to Stanley Lau, M.D., to purchase up to 80,000 shares of common stock (on a post stock-split basis).
4.4**Stock Purchase Warrant dated as of July 21, 2014, issued by Apollo Medical Holdings, Inc. to Yih Jen Kok, M.D., to purchase up to 20,000 shares of common stock (on a post stock-split basis).
4.5**Warrant to Purchase Common Stock dated as of February 20, 2015, issued by Apollo Medical Holdings, Inc. to RedChip Companies, Inc., to purchase up to 10,000 shares of common stock (on a post stock-split basis).
4.6*4.11 Common Stock Purchase Warrant dated as of October 14, 2015, issued by Apollo Medical Holdings, Inc. to Network Medical Management, Inc., to purchase up to 1,111,111 shares of common stock (filed as an exhibit to a Current Report on Form 8-K on October 19, 2015).
4.7*Common Stock Purchase Warrant dated as of March 30, 2016, issued by Apollo Medical Holdings, Inc. to Network Medical Management, Inc., to purchase up to 555,555 shares of common stock (filed as an exhibit to a Current Report on Form 8-K on April 4, 2016).


4.8*Common Stock Purchase Warrant dated as of November 4, 2016,issued by Apollo Medical Holdings, Inc.to Scott Enderby D.O., to purchase up to 24,000 shares of common stock (filed as an exhibit to a Current Report on Form 8-K on November 10, 2016).
4.9*Common Stock Purchase Warrant dated as of November 17, 2016, issued by Apollo Medical Holdings, Inc. to Liviu Chindris, M.D., (incorporated herein by reference to purchase upExhibit 4.1 to 5,000 shares of common stock (filed as an exhibit to athe Company’s Quarterly Report on Form 10-Q filed on February 14, 2017).
4.10*Form of Warrant to be Issued as Merger Consideration (as Annex C to the joint proxy statement/prospectus that is a part of the Registration Statement Amendment No. 2 on Form S-4/A filed on November 9, 2017).
   
10.1* Fifth Amendment to Registration Rights AgreementOffer Letter, dated June 5, 2018, between Apollo Medical Holdings, Inc. and NNAEric Chin
10.2Board of Nevada,Directors Agreement, dated June 21, 2018, between Apollo Medical Holdings, Inc., dated as of July 26, 2017 (filed as an exhibit and Ernest A. Bates, M.D. (incorporated herein by reference to aExhibit 10.1 to the Company’s Current Report on Form 8-K filed on July 28, 2017)June 26, 2018).
   
10.2*10.3 Amendment No. 1 to Intercompany Revolving LoanBoard of Directors Agreement, dated June 21, 2018, between Apollo Medical Management,Holdings, Inc. and Maverick Medical Group, dated as of August 31, 2017 (filed as an exhibitJoseph M. Molina, M.D. (incorporated herein by reference to aExhibit 10.2 to the Company’s Current Report on Form 8-K filed on September 6, 2017).
10.3*Amendment No. 1 to Subordination Agreement between Apollo Medical Management, Inc. and Maverick Medical Group, Inc., dated as of August 31, 2017 (filed as an exhibit to a Current Report on Form 8-K on September 6, 2017)June 26, 2018).
   
31.1** Certification by the Chief Executive Officer pursuant to Section 302 of the Sarbanes-Oxley Act of 2002 and Rules 13a-14 and 15d-14 under the Securities Exchange Act of 1934.
   
31.2**Certification by the Chief Executive Officer pursuant to Section 302 of the Sarbanes-Oxley Act of 2002 and Rules 13a-14 and 15d-14 under the Securities Exchange Act of 1934.
31.3* Certification by the Chief Financial Officer pursuant to Section 302 of the Sarbanes-Oxley Act of 2002 and Rules 13a-14 and 15d-14 under the Securities Exchange Act of 1934.
   
32*** Certification of Periodic Financial Report by the Chief Executive Officer and Chief Financial Officer pursuant to 18 U.S.C. §1350, as adopted pursuant to pursuant to Section 906 of the Sarbanes-Oxley Act of 2002.
   
101.INS** XBRL Instance Document
   
101.SCH** XBRL Taxonomy Extension Schema Document
   
101.CAL** XBRL Taxonomy Extension Calculation Linkbase Document

 52 

101.DEF** XBRL Taxonomy Extension Definition Linkbase
   
101.LAB** XBRL Taxonomy Extension Label Linkbase Document
   
101.PRE** XBRL Taxonomy Extension Presentation Linkbase Document
   
* Incorporated by referenceThe schedules and exhibits thereof have been omitted pursuant to Item 601(b)(2) of Regulation S-K. A copy of any omitted schedule or exhibit will be furnished to the respective exhibit of this Report.SEC upon request.
   
** Filed herewith.
   
*** Furnished herewith

 


53

SIGNATURE

 

Pursuant to the requirements of the Securities Exchange Act of 1934, the registrant has duly caused this report to be signed on its behalf by the undersigned thereunto duly authorized.

 

 APOLLO MEDICAL HOLDINGS, INC.
   
Dated: August 14, 2018By:/s/ Thomas Lam
Thomas Lam
Co-Chief Executive Officer
(Principal Executive Officer)
   
Dated: NovemberAugust 14, 20172018By:/s/ Mihir ShahWarren Hosseinion
  Mihir ShahWarren Hosseinion
Co-Chief Executive Officer
(Principal Executive Officer)
Dated: August 14, 2018By:/s/ Eric Chin
Eric Chin
  Chief Financial Officer
  (Principal Financial and Accounting Officer)


54